title: Rotational thromboelastometry in prediction of bleeding after cardiac surgery.
abstract: BACKGROUND
  Reexploration and its associated complications significantly affect hospital mortality and morbidity. Therefore, to prevent postoperative bleeding and its related complications, using an appropriate modality is essential during cardiac surgery.
  
  
  METHODS
  Four hundred patients (296 males and 104 females, mean age 60.8 ± 9 years) scheduled for first-time coronary artery bypass graft surgery were prospectively enrolled. Blood samples were obtained for ROTEM testing before surgery and 30 min after heparin reversal. The patients were divided into 2 groups: group 1 was patients with no abnormal postoperative bleeding and group 2 was patients who required reexploration for abnormal postoperative bleeding. Group 2 patients were divided into 2 subgroups: 2a was patients with surgical bleeding and group 2b was patients with nonsurgical bleeding. Variables were compared between groups.
  
  
  RESULTS
  Among the 400 patients, 42 were reexplored. Hospital stay was significantly longer and hospital deaths more frequent in group 2 patients (p < 0.001 and p = 0.010, respectively). Ten (2.8%) patients had abnormal preoperative results of ROTEM in group 1 compared to 14 (33.3%) in group 2 (p < 0.001). After surgery, the number of patients with abnormal ROTEM results was significantly different between the 2 groups: 6 (1.7%) in group 1 vs. 14 (33.3%) in group 2 (p < 0.001). Four (12.5%) patients in group 2a had abnormal preoperative ROTEM results compared to 10 (100%) in group 2a (p < 0.001).
  
  
  CONCLUSIONS
  Measuring coagulation factors by ROTEM both before surgery and after heparin reversal can identify patients at increased risk of postoperative bleeding.
authors.affiliation: Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza Alizadeh
authors.initials: AA
authors.lastname: Ghavidel
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Zia
authors.initials: Z
authors.lastname: Toutounchi
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Farshad Jalili
authors.initials: FJ
authors.lastname: Shahandashti
authors.affiliation: Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran yalda_2m@yahoo.com.
authors.forename: Yalda
authors.initials: Y
authors.lastname: Mirmesdagh
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D001026:Coronary Artery Bypass; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013916:Thrombelastography / Q000379:methods*
chemical_list: D006493:Heparin
keywords: Blood coagulation; cardiac surgical procedures; coronary artery bypass; postoperative hemorrhage; reoperation; thrombelastography