title: Thromboelastography (TEG)-based algorithm reduces blood product utilization in patients undergoing VAD implant.
abstract: OBJECTIVE
  Multiple blood products are often required during and after ventricular assist device (VAD) implants. Generally, transfusion therapy is empirically guided by conventional laboratory tests. In this study, we aimed to compare a thromboelastography (TEG)-based algorithm with a laboratory coagulation test-based algorithm with respect to blood product utilization in patients undergoing VAD implant.
  
  
  METHODS
  From June 2010 to May 2012, a total of 39 consecutive patients underwent VAD implantation. Patients undergoing VAD implant were retrospectively divided into two groups according to transfusion strategy. In the control group (n=20), the need for blood transfusion was based on clinician's discretion according to standard coagulation test results. In the TEG group (n=19), a strict protocol based on TEG parameters was followed for the usage of all perioperative blood products. Coagulation factors, TEG parameters, and blood transfusions were documented and compared between these two groups.
  
  
  RESULTS
  There were no differences in demographic variables with the exception of a decreased CPB time in the TEG group (p=0.019). Prothrombin time (PT) (p<0.001) and international normalized ratio (INR) (p<0.001) in the postprotamine interval were significantly higher in the TEG group than in the control group. No significant difference was detected in any coagulation variable in the postoperative (ICU) period between the two groups. Platelet counts decreased in a linear fashion from baseline to the postoperative period in the two groups (p<0.001). Patients in the TEG group received significantly less fresh-frozen plasma in both the intraoperative (p=0.005) and postoperative (p=0.014) periods. Patients in the TEG group also received significantly less platelets both in the postoperative (p=0.03) period and in total amount (p=0.033). There was no difference in consumption of packed red blood cell units between the two groups.
  
  
  CONCLUSIONS
  Our results show that the strict use of a TEG-guided algorithm significantly reduces the consumption of blood products in patients undergoing VAD implant
authors.forename: Wenyu
authors.initials: W
authors.lastname: Sun
authors.forename: Ken
authors.initials: K
authors.lastname: Jeleniowski
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Peter
authors.initials: P
authors.lastname: Shen
authors.forename: Dadong
authors.initials: D
authors.lastname: Li
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Hammond
mesh_terms: D000368:Aged; D000465:Algorithms; D001780:Blood Coagulation Tests / Q000379:methods*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000706:statistics & numerical data*; D059035:Perioperative Period; D010949:Plasma; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*