title: Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study.
abstract: This retrospective, observational study compared the impact of a point-of-care rotational thromboelastometry (ROTEM®) method versus conventional bleeding management in terms of postoperative (24-h) blood loss, intraoperative and postoperative (24-h) transfusion requirement and length of stay in the postoperative intensive care unit (ICU) in patients undergoing cardiac surgery. Forty consecutive patients undergoing cardiac surgery under ROTEM®-guided hemostatic management were enrolled; the control population included 40 selected patients undergoing similar interventions without ROTEM®monitoring. Significantly more patients in the thromboelastometry group versus the control group received fibrinogen (45 vs 10 %; p < 0.0001), while fewer received a transfusion (40 vs 72.5 %; p < 0.0033). Compared with control group patients, those in the thromboelastometry group had less postoperative bleeding (285 vs 393 mL; p < 0.0001), a shorter time from cardiopulmonary bypass discontinuation to skin suture (79.3 vs 92.6 min; p = 0.0043) and a shorter stay in the ICU (43.7 vs 52.5 h; p = 0.0002). In our preliminary experience, ROTEM®-guided bleeding management was superior to conventional management of bleeding in patients undergoing complex cardiac surgery with cardiopulmonary bypass in terms of reduced postoperative blood loss, transfusion requirement, and length of ICU stay.
authors.affiliation: Anesthesiology and Intensive Care Unit, Department of Medicine, Institute of Anesthesia and Intensive Care, University of Padua, Via Cesare Battisti 267, 35121, Padua, Italy. francesco.vasques@hotmail.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vasques
authors.affiliation: Department of Medicine, Thrombophilia and Hemophilia Center, University of Padua, Padua, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Spiezia
authors.affiliation: Anesthesiology and Intensive Care Unit, Department of Medicine, Institute of Anesthesia and Intensive Care, University of Padua, Via Cesare Battisti 267, 35121, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Manfrini
authors.affiliation: Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Fichera
authors.affiliation: Department of Medicine, Thrombophilia and Hemophilia Center, University of Padua, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
authors.affiliation: Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Anesthesiology and Intensive Care Unit, Department of Medicine, Institute of Anesthesia and Intensive Care, University of Padua, Via Cesare Battisti 267, 35121, Padua, Italy.|Institute of Anesthesia and Intensive Care, Azienda Ospedaliera di Padova, Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
authors.affiliation: Institute of Anesthesia and Intensive Care, Azienda Ospedaliera di Padova, Padua, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Di Gregorio
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*
chemical_list: D005340:Fibrinogen
keywords: Adult; Bleeding; Cardiac surgery; ROTEM®; Thromboelastometry