title: Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients.
abstract: Severe bleeding related to cardiac surgery is associated with increased morbidity and mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are point-of-care tests (POCT). Bedside ROTEM/TEG can rapidly detect changes in blood coagulation and therefore provide a goal-directed, individualized coagulation therapy. In this meta-analysis, we aimed to determine the current evidence for or against POCT-guided algorithm in patients with severe bleeding after cardiac surgery.
  
  
  
  We performed a meta-analysis of randomized controlled trials and observational trials retrieved from a literature search in PubMed, EMBASE, and Cochrane Library. Only trials comparing transfusion strategy guided by TEG/ROTEM with a standard of care control group undergoing cardiac surgery were included. In addition, at least one clinical outcome had to be mentioned: mortality, surgical re-exploration rate, sternal wound infection, and acute kidney injury (AKI). Also, surrogate parameters such as transfusion requirements and amount of blood loss were analyzed. The pooled treatment effects (odds ratio [OR] and 95% confidence intervals [CI]) were assessed using a fixed or random-effects model.
  
  
  
  The literature search retrieved a total of 17 trials (nine randomized controlled trial and eight observational trials) involving 8332 cardiac surgery patients. POCT-guided transfusion management significantly decreased the odds for patients to receive allogeneic blood products (OR 0.63, 95% CI 0.56-0.71; P < 0.00001) and the re-exploration rate due to postoperative bleeding (OR 0.56, 95% CI 0.45-0.71; P < 0.00001). Furthermore, the incidence of postoperative AKI (OR 0.77, 95% CI 0.61-0.98; P = 0.0278) and thromboembolic events (OR 0.44, 95% CI 0.28-0.70; P = 0.0006) was significantly decreased in the TEG/ROTEM group. No statistical differences were found with regard to inhospital mortality, cerebrovascular accident, or length of intensive care unit and hospital stay.
  
  
  
  TEG/ROTEM-based coagulation management decreases the risk of allogeneic blood product exposure after cardiac surgery. Furthermore, it results in significantly lower re-exploration rate, decreased incidence of postoperative AKI, and thromboembolic events in cardiac surgery patients. Results of this meta-analysis indicate that POCT-guided transfusion therapy is superior to the current standard of care.
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. Electronic address: antje-christin.deppe@uk-koeln.de.
authors.forename: Antje-Christin
authors.initials: AC
authors.lastname: Deppe
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Weber
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Zimmermann
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Elmar W
authors.initials: EW
authors.lastname: Kuhn
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Slottosch
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Liakopoulos
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany; Center of Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000465:Algorithms; D001803:Blood Transfusion / Q000379:methods*; D006348:Cardiac Surgical Procedures; D000066491:Clinical Decision-Making / Q000379:methods; D003661:Decision Support Techniques; D006801:Humans; D015233:Models, Statistical; D019095:Point-of-Care Systems; D019106:Postoperative Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome
keywords: Bleeding; Cardiac surgery; Point-of-care testing; Thromboelastography; Thromboelastometry; Transfusion management