Key result
ROTEM in addition to routine coagulation tests significantly reduced postoperative consumption of packed blood cells compared to traditional tests alone (387.50 vs 645.17, P=0.03).
Why the study?
Does ROTEM-guided hemostatic management reduce postoperative bleeding volume and consumption of blood products in adult patients undergoing cardiac surgery?
Cohort (n=50)
Does ROTEM-guided hemostatic management reduce postoperative bleeding volume and consumption of blood products in adult patients undergoing cardiac surgery?
Absolute Event Rate: 387.5% vs 645.17%
p-value: p=0.03
ROTEM-guided hemostatic management during cardiac surgery significantly reduces postoperative consumption of packed red blood cells compared to traditional coagulation tests alone.
May support ROTEM to limit transfusions in cardiac surgery; leaves open confirmation in randomized trials.
Background: Coagulopathy after cardiopulmonary bypass (CPB) may lead to increased morbidity and mortality. Routine conventional coagulation tests are not always suitable to detect rapid changes in patient’s coagulation status. A point-of-care instrument such as ROTEM (rotational thromboelastometry) is a timely and comprehensive method to evaluate hemostasis during cardiac surgery may reduce the need for blood transfusion. Objectives: In this study, ROTEMwas compared to coagulation tests routinely performed during cardiac surgery for postoperative bleeding volume and consumption of blood products. Patients and Methods: Fifty patients undergoing cardiac surgical procedures were enrolled. Blood was obtained before the operation and after CPB weaning. Twenty-five of patients were checked only by traditional blood coagulation test and 25 other patients were checked by ROTEM in addition to routine coagulation tests. The results of these two groups of patients were compared. Results: There was a significant correlation between platelet count (PLT) and fibrinogen level with EXTEM-MCF (r = 0.79, P value: 0.008, r = 0.55, P value: 0.04 respectively). EXTEM-CT was correlated with prothrombin time (PT) (r = 0.56, P value: 0.01) and International normalized Ratio (INR) (r = 0.57, P value: 0.01). There was a significant correlation between PLT count and fibrinogen level with INTEM-MCF (r = 0.69, P value: 0.02, r = 0.71, P value: 0.01, respectively). INTEM-CT was correlated with partial thromboplastin time (PTT) (r = 0.57, P value: 0.02). There was a significant correlation between FIBTEM-MCF and fibrinogen level (r = 0.80, P value: 0.001). HEPTEM was not correlated with any of the coagulation variables. Postoperative consumption of packed blood cell (BPC) was increased in non-ROTEM group in comparison with ROTEM group (645.17 ± 279.16 in Non-ROTEM vs. 387.50 ± 262.88 in ROTEM, P: 0.03) Conclusions: ROTEM can be used to detect postoperative hemostatic changes following cardiac surgery appropriately and can be useful to choose suitable blood products that may reduce the need for blood transfusion, contributing to better patient blood management.
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Golpira et al. (2016) conducted a cohort in Coagulopathy after cardiopulmonary bypass in cardiac surgery (n=50). ROTEM (rotational thromboelastometry) in addition to routine coagulation tests vs. Traditional blood coagulation tests only was evaluated on Postoperative consumption of packed blood cells (p=0.03). ROTEM in addition to routine coagulation tests significantly reduced postoperative consumption of packed blood cells compared to traditional tests alone (387.50 vs 645.17, P=0.03).
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