title: Thromboelastography can Identify Postoperative Active Bleeding and Evaluate Blood Product Requirements in Abdominal Surgery.
abstract: OBJECTIVE
  Hemorrhage after abdominal surgery remains a frequent clinical complication, and associated with prolonged length of stay, increased complications and mortality. Indication of blood product requirements accurately and promptly is very important for recovery of patients. Thrombelastography (TEG) as a tool for evaluation of bleeding and effects of blood components and blood products is increasing. We investigated that whether TEG can identify postoperative active bleeding and evaluate blood product requirements in abdominal surgery.
  
  
  METHODS
  Between June to December in 2012, there were 55 patients who had bleeding after operation in SICU of Jinling Hospital. Recorded data included vital signs (MAP, heart rate, respiratory rate, blood oxygen saturation), urine volume per hour, blood routine (Hb, Hct, Plt), the coagulation tests (Fib, PT, aPTT, INR), TEG parameters (R, K, Angle, MA, Cl) and blood product requirements within 24h. Patients were divided into active bleeding group and non-active bleeding group based on the findings of reoperation or digital subtraction angiography (DSA). To compare vital signs, laboratory values, TEG values and blood product requirements in two groups.
  
  
  RESULTS
  Vital signs (MAP, heart rate, respiratory rate, blood oxygen saturation), urine volume per hour and the coagulation tests (Fib, PT, INR) showed no significant correlations with subsequent blood product requirements, but aPTT (R = 0.546, P = 0.000) and MA (R = 0.665, P = 0.000) correlated with the blood products use. MA values of patients had more blood loss was significantly lower and had a descending tendency which did not showed in aPTT values. 25 patients had postoperative active bleeding confirmed by reoperation or DSA. They had significantly increased use of blood products, and significantly lower MA, Hb, Hct, and Fib values, whereas aPTT exhibited no significant differences.
  
  
  CONCLUSIONS
  MA can not only identify postoperative active bleeding together with hemoglobin, hematocrit, and fibrinogen, but also evaluate blood product requirements in abdominal surgery.
authors.forename: Juan-Juan
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Wen-Kui
authors.initials: WK
authors.lastname: Yu
authors.forename: Tao
authors.initials: T
authors.lastname: Gao
authors.forename: Feng-Chan
authors.initials: FC
authors.lastname: Xi
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Zhu
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Jie-Shou
authors.initials: JS
authors.lastname: Li
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000379:methods*; D002681:China; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013916:Thrombelastography; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D005340:Fibrinogen