Why the study?
Bleeding complications are common in cardiac surgery and increase morbidity and mortality, requiring rapid point-of-care coagulation assessment to guide targeted therapy.
Viscoelastic testing provides rapid, point-of-care assessment of coagulation in cardiac surgery, allowing for targeted therapy that reduces bleeding and transfusion requirements.
May guide targeted transfusion in cardiac surgery; leaves open need for outcome-focused RCTs.
Bleeding complications are common in cardiac surgery and lead to an increase in morbidity and mortality. This is multifactorial in aetiology including the effects of cardiopulmonary bypass, the drugs given to manipulate the coagulation system and the vascular nature of the surgery itself. Viscoelastic tests provide a point of care, rapid assessment of coagulation which offer the advantage of faster turnaround times and a nuanced view of the elements of the coagulation system allowing targeted therapy to be delivered quickly. Both thomboelastography (TEG)and thromboelastometry (ROTEM) have been recommended for use in cardiac surgery, both have shown a reduction in transfusion and bleeding when used as part of a testing algorithm. They are particularly useful in assessing residual heparinisation and fibrinogen levels. Additionally, TEG allows the evaluation of the effects of anti-platelet agents on platelet function. This review discusses the mechanisms by which bleeding occurs in cardiac surgery and explores three uses of viscoelastic testing in cardiac surgery: to predict bleeding, to assess platelet function and peri-operative testing to reduce transfusion.
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Agarwal et al. (2020) studied this question.
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