JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (194)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shore-Lesserson, L.
Right arrow Articles by Ergin, M. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shore-Lesserson, L.
Right arrow Articles by Ergin, M. A.
Anesth Analg 1999;88:312
© 1999 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

Thromboelastography-Guided Transfusion Algorithm Reduces Transfusions in Complex Cardiac Surgery

Linda Shore-Lesserson, MD*, Heather E. Manspeizer, MD*, Marietta DePerio, RN*, Sanjeev Francis, BS*, Frances Vela-Cantos, RN*, and M. Arisan Ergin, MD, PhD{dagger}

Departments of *Anesthesiology and {dagger}Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York

Address correspondence and reprint requests to Linda Shore-Lesserson, MD, Department of Anesthesiology, One Gustave L. Levy Place, Box 1010, New York, NY 10029. Address e-mail to linda_shore{at}smtplink.mssm.edu

Transfusion therapy after cardiac surgery is empirically guided, partly due to a lack of specific point-of-care hemostasis monitors. In a randomized, blinded, prospective trial, we studied cardiac surgical patients at moderate to high risk of transfusion. Patients were randomly assigned to either a thromboelastography (TEG)-guided transfusion algorithm (n = 53) or routine transfusion therapy (n = 52) for intervention after cardiopulmonary bypass. Coagulation tests, TEG variables, mediastinal tube drainage, and transfusions were compared at multiple time points. There were no demographic or hemostatic test result differences between groups, and all patients were given prophylactic antifibrinolytic therapy. Intraoperative transfusion rates did not differ, but there were significantly fewer postoperative and total transfusions in the TEG group. The proportion of patients receiving fresh-frozen plasma (FFP) was 4 of 53 in the TEG group compared with 16 of 52 in the control group (P < 0.002). Patients receiving platelets were 7 of 53 in the TEG group compared with 15 of 52 in the control group (P < 0.05). Patients in the TEG group also received less volume of FFP (36 ± 142 vs 217 ± 463 mL; P < 0.04). Mediastinal tube drainage was not statistically different 6, 12, or 24 h postoperatively. Point-of-care coagulation monitoring using TEG resulted in fewer transfusions in the postoperative period. We conclude that the reduction in transfusions may have been due to improved hemostasis in these patients who had earlier and specific identification of the hemostasis abnormality and thus received more appropriate intraoperative transfusion therapy. These data support the use of TEG in an algorithm to guide transfusion therapy in complex cardiac surgery.

Implications: Transfusion of allogeneic blood products is common during complex cardiac surgical procedures. In a prospective, randomized trial, we compared a transfusion algorithm using point-of-care coagulation testing with routine laboratory testing, and found the algorithm to be effective in reducing transfusion requirements.




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
N. Rahe-Meyer, C. Solomon, M. Winterhalter, S. Piepenbrock, K. Tanaka, A. Haverich, and M. Pichlmaier
Thromboelastometry-guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery
J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 694 - 702.
[Abstract] [Full Text] [PDF]

Home page
 American Journal of Medical QualityHome page
F. W. Maddux, T. A. Dickinson, D. Rilla, R. W. Kamienski, S. P. Saha, F. Eales, A. Rego, H. W. Donias, S. L. Crutchfield, and R. A. Hardin
Institutional Variability of Intraoperative Red Blood Cell Utilization in Coronary Artery Bypass Graft Surgery
American Journal of Medical Quality, September 1, 2009; 24(5): 403 - 411.
[Abstract] [PDF]

Home page
 Br J AnaesthHome page
N. Rahe-Meyer, M. Pichlmaier, A. Haverich, C. Solomon, M. Winterhalter, S. Piepenbrock, and K. A. Tanaka
Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study
Br. J. Anaesth., June 1, 2009; 102(6): 785 - 792.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. Lang, K. Johanning, H. Metzler, S. Piepenbrock, C. Solomon, N. Rahe-Meyer, and K. A. Tanaka
The Effects of Fibrinogen Levels on Thromboelastometric Variables in the Presence of Thrombocytopenia
Anesth. Analg., March 1, 2009; 108(3): 751 - 758.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J.-F. Hardy, S. Belisle, and P. Van der Linden
Efficacy and Safety of Recombinant Activated Factor VII to Control Bleeding in Nonhemophiliac Patients: A Review of 17 Randomized Controlled Trials
Ann. Thorac. Surg., September 1, 2008; 86(3): 1038 - 1048.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J. Dunning, M. Versteegh, A. Fabbri, A. Pavie, P. Kolh, U. Lockowandt, S. A.M. Nashef, and on behalf of the EACTS Audit and Guidelines Commit
Guideline on antiplatelet and anticoagulation management in cardiac surgery.
Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 73 - 92.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. T. Ganter and C. K. Hofer
Coagulation Monitoring: Current Techniques and Clinical Use of Viscoelastic Point-of-Care Coagulation Devices
Anesth. Analg., May 1, 2008; 106(5): 1366 - 1375.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. Haas, D. Fries, C. Velik-Salchner, E. Oswald, and P. Innerhofer
Fibrinogen in Craniosynostosis Surgery
Anesth. Analg., March 1, 2008; 106(3): 725 - 731.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
K. A. Tanaka, T. Taketomi, F. Szlam, A. Calatzis, and J. H. Levy
Improved Clot Formation by Combined Administration of Activated Factor VII (NovoSeven(R)) and Fibrinogen (Haemocomplettan(R) P)
Anesth. Analg., March 1, 2008; 106(3): 732 - 738.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
Z. N. Kon, E. N. Brown, M. C. Grant, T. Ozeki, N. S. Burris, M. J. Collins, M. H. Kwon, and R. S. Poston
Warm ischemia provokes inflammation and regional hypercoagulability within the heart during off-pump coronary artery bypass: a possible target for serine protease inhibition
Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 215 - 221.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
C. C. Harle
Point-of-Care Platelet Function Testing
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 247 - 251.
[Abstract] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
G. J. Spalding, M. Hartrumpf, T. Sierig, N. Oesberg, C. G. Kirschke, and J. M. Albes
Cost reduction of perioperative coagulation management in cardiac surgery: value of 'bedside' thrombelastography (ROTEM)
Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1052 - 1057.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al.
Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline
Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86.
[Abstract] [Full Text] [PDF]

Home page
 Contin Educ Anaesth Crit Care PainHome page
A. N. Curry and J. T. Pierce
Conventional and near-patient tests of coagulation
CEACCP, April 1, 2007; 7(2): 45 - 50.
[Full Text] [PDF]

Home page
 PerfusionHome page
W. Yap, D. Young, and V. Pathi
Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass - a randomised controlled trial
Perfusion, January 1, 2007; 22(1): 57 - 61.
[Abstract] [PDF]

Home page
 Br J AnaesthHome page
B. Haizinger, H. Gombotz, P. Rehak, G. Geiselseder, and R. Mair
Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children
Br. J. Anaesth., October 1, 2006; 97(4): 545 - 552.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. S. Poston, C. White, J. Gu, J. Brown, J. Gammie, R. N. Pierson, A. Lee, I. Connerney, T. Avari, R. Christenson, et al.
Aprotinin Shows Both Hemostatic and Antithrombotic Effects During Off-Pump Coronary Artery Bypass Grafting
Ann. Thorac. Surg., January 1, 2006; 81(1): 104 - 111.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
S. W Sutton, M. A Duncan, V. A Chase, R. J Marcel, T. P Meyers, and R. E Wood
Cardiopulmonary bypass and mitral valve replacement during pregnancy
Perfusion, December 1, 2005; 20(6): 359 - 368.
[Abstract] [PDF]

Home page
 ICVTSHome page
A. Ronald and J. Dunning
Can the use of thromboelastography predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?
Interactive CardioVascular and Thoracic Surgery, October 1, 2005; 4(5): 456 - 463.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. V. Manchio, J. Gu, L. Romar, J. Brown, J. Gammie, R. N. Pierson III, B. Griffith, and R. S. Poston
Disruption of Graft Endothelium Correlates With Early Failure After Off-Pump Coronary Artery Bypass Surgery
Ann. Thorac. Surg., June 1, 2005; 79(6): 1991 - 1998.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
R. Poston, J. Gu, J. Manchio, A. Lee, J. Brown, J. Gammie, C. White, and B. P. Griffith
Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting
Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 584 - 591.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
A. Shander, D. Moskowitz, and T. S. Rijhwani
The Safety and Efficacy of "Bloodless" Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 53 - 63.
[Abstract] [PDF]

Home page
 Br J AnaesthHome page
P. Diprose, M. J. Herbertson, D. O'Shaughnessy, C. D. Deakin, and R. S. Gill
Reducing allogeneic transfusion in cardiac surgery: a randomized double-blind placebo-controlled trial of antifibrinolytic therapies used in addition to intra-operative cell salvage
Br. J. Anaesth., March 1, 2005; 94(3): 271 - 278.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. F. James, H. E. Potgieter, and P. Ellis
The Effect of Hemopure(R) on Coagulation in Clinically Relevant Concentrations
Anesth. Analg., December 1, 2004; 99(6): 1593 - 1597.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. J. Chavez, D. E. Foley, C. C. Snider, J. C. Howell, E. Cohen, R. A. Muenchen, and R. C. Carroll
A Novel Thrombelastograph(R) Tissue Factor/Kaolin Assay of Activated Clotting Times for Monitoring Heparin Anticoagulation During Cardiopulmonary Bypass
Anesth. Analg., November 1, 2004; 99(5): 1290 - 1294.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. Kawasaki, N. Katori, M. Kodaka, H. Miyao, and K. A. Tanaka
Electron Microscopic Evaluations of Clot Morphology During Thrombelastography(R)
Anesth. Analg., November 1, 2004; 99(5): 1440 - 1444.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
K. F. J. Ng
Changes in ThrombelastographTM Variables Associated with Aging
Anesth. Analg., August 1, 2004; 99(2): 449 - 454.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
V. G. Nielsen, W. Q. Gurley Jr, and T. M. Burch
The Impact of Factor XIII on Coagulation Kinetics and Clot Strength Determined by Thrombelastography
Anesth. Analg., July 1, 2004; 99(1): 120 - 123.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. M. Moskowitz, J. J. Klein, A. Shander, K. M. Cousineau, R. S. Goldweit, C. Bodian, S. I. Perelman, H. Kang, D. A. Fink, H. C. Rothman, et al.
Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center
Ann. Thorac. Surg., February 1, 2004; 77(2): 626 - 634.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. S. Avidan, E. L. Alcock, J. Da Fonseca, J. Ponte, J. B. Desai, G. J. Despotis, and B. J. Hunt
Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery
Br. J. Anaesth., February 1, 2004; 92(2): 178 - 186.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
B. E. Miller, N. A. Guzzetta, S. R. Tosone, J. L. Miller, A. R. Flunker, E. M. Silvey, and J. H. Levy
Tissue Factor-Activated Thromboelastograms in Children Undergoing Cardiac Surgery: Baseline Values and Comparisons
Anesth. Analg., November 1, 2003; 97(5): 1289 - 1293.
[Abstract] [Full Text] [PDF]

Home page
 TraumaHome page
A. M Roche and M. F. James
Watering down the clots, or are we?
Trauma, October 1, 2003; 5(4): 235 - 244.
[Abstract] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
V. A. Bowbrick, D. P. Mikhailidis, and G. Stansby
Value of Thromboelastography in the Assessment of Platelet Function
Clinical and Applied Thrombosis/Hemostasis, April 1, 2003; 9(2): 137 - 142.
[Abstract] [PDF]

Home page
 Br J AnaesthHome page
R. R. Johi, M. H. Cross, and S. D. Hansbro
Near-patient testing for coagulopathy after cardiac surgery{dagger}
Br. J. Anaesth., April 1, 2003; 90(4): 499 - 501.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
B. S. Donahue, D. Gailani, M. S. Higgins, D. C. Drinkwater, and A. L. George Jr
Factor V Leiden Protects Against Blood Loss and Transfusion After Cardiac Surgery
Circulation, February 25, 2003; 107(7): 1003 - 1008.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
U. Cammerer, W. Dietrich, T. Rampf, S. L. Braun, and J. A. Richter
The Predictive Value of Modified Computerized Thromboelastography and Platelet Function Analysis for Postoperative Blood Loss in Routine Cardiac Surgery
Anesth. Analg., January 1, 2003; 96(1): 51 - 57.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
V. G. Nielsen
The Detection of Changes in Heparin Activity in the Rabbit: A Comparison of Anti-Xa Activity, Thrombelastography(R), Activated Partial Thromboplastin Time, and Activated Coagulation Time
Anesth. Analg., December 1, 2002; 95(6): 1503 - 1506.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
J. Boldt, G. Haisch, S. Suttner, B. Kumle, and A. Schellhaass
Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend(R)) on measures of coagulation
Br. J. Anaesth., November 1, 2002; 89(5): 722 - 728.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. J. P. Harnett, K. Bhavani-Shankar, S. Datta, and L. C. Tsen
In Vitro Fertilization-Induced Alterations in Coagulation and Fibrinolysis as Measured by Thromboelastography
Anesth. Analg., October 1, 2002; 95(4): 1063 - 1066.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. Boldt, G. Haisch, S. Suttner, B. Kumle, and F. Schellhase
Are Lactated Ringer's Solution and Normal Saline Solution Equal with Regard to Coagulation?
Anesth. Analg., February 1, 2002; 94(2): 378 - 384.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
S. Samson and L. Shore-Lesserson
Platelet Function and Cardiopulmonary Bypass
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 273 - 281.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
K. Kottke-Marchant and S. Sapatnekar
Hemostatic Abnormalities in Cardiopulmonary Bypass: Pathophysiologic and Transfusion Considerations
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 187 - 206.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
L. Shore-Lesserson
Monitoring the Hematologic Complications of Cardiopulmonary Bypass
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 207 - 216.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
N. J. Skubas and G. J. Despotis
Optimal Management of Bleeding Complications After Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 217 - 228.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
H. E. Manspeizer, M. Imai, R. J. Frumento, M. K. Parides, B. Mets, and E. Bennett-Guerrero
Arterial and Venous Thrombelastograph(R) Variables Differ During Cardiac Surgery
Anesth. Analg., August 1, 2001; 93(2): 277 - 281.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
D. Royston and S. von Kier
Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass
Br. J. Anaesth., April 1, 2001; 86(4): 575 - 578.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
C. M. Samama
Thromboelastography: The Next Step
Anesth. Analg., March 1, 2001; 92(3): 563 - 564.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
E. Mahla, T. Lang, M. N. Vicenzi, G. Werkgartner, R. Maier, C. Probst, and H. Metzler
Thromboelastography for Monitoring Prolonged Hypercoagulability After Major Abdominal Surgery
Anesth. Analg., March 1, 2001; 92(3): 572 - 577.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. J. Despotis and L. T. Goodnough
Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery
Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
V. G. Nielsen, B. T. Geary, and M. S. Baird
Evaluation of the Contribution of Platelets to Clot Strength by Thromboelastography in Rabbits: The Role of Tissue Factor and Cytochalasin D
Anesth. Analg., July 1, 2000; 91(1): 35 - 39.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
B. E. Miller, N. A. Guzzetta, S. R. Tosone, and J. H. Levy
Rapid Evaluation of Coagulopathies After Cardiopulmonary Bypass in Children Using Modified Thromboelastography
Anesth. Analg., June 1, 2000; 90(6): 1324 - 1330.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
E. P. Stover, L. C. Siegel, P. A. Hood, G. E. O’Riordan, and T. R. McKenna
Platelet-Rich Plasma Sequestration, with Therapeutic Platelet Yields, Reduces Allogeneic Transfusion in Complex Cardiac Surgery
Anesth. Analg., March 1, 2000; 90(3): 509 - 516.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
V. N. R. Gottumukkala, S. K. Sharma, and J. Philip
Assessing Platelet and Fibrinogen Contribution to Clot Strength Using Modified Thromboelastography in Pregnant Women
Anesth. Analg., December 1, 1999; 89(6): 1453 - 1453.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 1999 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1999 by the International Anesthesia Research Society.