Key result
Thrombelastography-guided surgical timing for CABG patients on dual antiplatelet therapy did not significantly reduce 24-hour postoperative chest drainage volume compared to standard timing (435 ml vs 488 ml, P=0.287).
Why the study?
Does TEG-guided surgical timing reduce bleeding and waiting time in ACS patients on DAPT scheduled for CABG?
RCT (n=90)
Randomly allocated
No
Does TEG-guided surgical timing reduce bleeding and waiting time in ACS patients on DAPT scheduled for CABG?
TEG-guided surgical timing for CABG in ACS patients on DAPT safely reduces waiting time, hospital length of stay, and total bleeding amount compared to a standard 5-7 day waiting period.
The guiding value of thrombelastography (TEG) on the selection of surgical timing for patients scheduled for coronary artery bypass grafting (CABG) was investigated. A total of 90 subjects with acute coronary syndrome (ACS) treated between February 2014 and December 2016 in Henan Provincial People's Hospital were recruited. The patients received dual antiplatelet therapy (DAPT) and were scheduled for CABG. Subjects were randomly allocated into two groups, TEG group (n=45) and non‑TEG group (n=45). Patients in the TEG group withheld medications at 24 h prior to surgery and received TEG examination. Based on maximum amplitude of adenosine diphosphate (MAADP), subjects were further grouped into three sub‑groups with MAADP <35 mm, 35‑50 mm, and >50 mm, and accordingly received CABG within 1 day, 3‑5 days and 5 days later, respectively. Subjects in the control group (non‑TEG group) received CABG 5‑7 days after medication withdrawal. Chest drainage volume within 24 h after surgery and red blood cell transfusion during perioperative period were compared. Other recorded parameters were incubation period, intensive care unit length of stay, hospital stay, incidence of 30‑day adverse events and readmission rate. The average waiting time before CABG for patients of TEG group was shorter compared with the commonly recommended time. The red blood cell transfusions during perioperative period of subjects in TEG group and non‑TEG group were significantly different (P=0.23). The median hospital stay of subjects in TEG group was shorter than that of non‑TEG group (P=0.037). The bleeding amount of patients in TEG group was 220.16±80.56 ml, which was significantly lower than that of non‑TEG group (435.29±90.16). The difference was statistically significant (P=0.032). The results suggested that TEG assay‑based evaluation of platelet function for patients scheduled for CABG reasonably guides surgeons with appropriate surgical timing and reduces the amount of time patients wait to be treated.
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Yang et al. (2018) conducted an RCT in Acute coronary syndrome scheduled for coronary artery bypass grafting (n=90). Thrombelastography (TEG) guided surgical timing vs. Standard surgical timing (5-7 days after medication withdrawal) was evaluated on Chest drainage volume within 24 h after surgery (p=0.287). Thrombelastography-guided surgical timing for CABG patients on dual antiplatelet therapy did not significantly reduce 24-hour postoperative chest drainage volume compared to standard timing (435 ml vs 488 ml, P=0.287).
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