Ak Koray, Isbir Cemil S, Tetik Sermin, Atalan Nazan, Tekeli Atike, Aljodi Maher, Civelek Ali, Arsan Sinan
Department of Cardiovascular Surgery, School of Medicine, Marmara University, Istanbul, Turkey.
J Card Surg. 2009 Jul-Aug;24(4):404-10. doi: 10.1111/j.1540-8191.2009.00840.x.
Bleeding and allogeneic transfusion remain constant problems in cardiac surgical procedures. In this study, we aimed to test the role of a routine thromboelastography (TEG)-based algorithm on bleeding and transfusions in patients undergoing elective coronary artery bypass grafting (CABG).
Patients (n = 224) undergoing elective CABG with cardiopulmonary bypass were prospectively randomized into two groups according to transfusion strategy: in group 1 (clinician-directed transfusion, n = 110) need for blood transfusion was based on clinician's discretion and standard coagulation tests and in group 2 (TEG algorithm group, n = 114) kaolin-activated (k) TEG-based algorithm-guided perioperative transfusion management. Transfusion, blood loss, and outcome data were recorded.
There were no differences in consumption of packed cell units, blood loss, re-exploration for bleeding, and early clinical outcome between the groups. Patients in the TEG group had significantly lower median units of fresh frozen plasma and platelets compared with the other group (p = 0.001). The median number of total allogeneic units transfused (packed cells and blood products) was significantly reduced in the TEG group compared with the other group (median 2, range 1-3 units vs. median 3, range 2-4 units, respectively, p = 0.001). The need for tranexamic acid was significantly diminished in the TEG group compared with the other group (10.3% vs. 19%, respectively, p = 0.007).
Our results show that routine use of a kTEG-guided algorithm reduces the consumption of blood products in patients undergoing elective CABG. Adopting such an algorithm into routine management of these patients may help to improve clinical outcome and reduce the potential risks of transfusion-related complications and total costs after CABG.
出血和异体输血仍是心脏外科手术中持续存在的问题。在本研究中，我们旨在测试基于常规血栓弹力图（TEG）的算法在择期冠状动脉旁路移植术（CABG）患者出血和输血方面的作用。
对224例接受体外循环择期CABG的患者，根据输血策略前瞻性随机分为两组：第1组（临床医生指导输血组，n = 110），输血需求基于临床医生的判断和标准凝血试验；第2组（TEG算法组，n = 114），采用基于高岭土激活（k）TEG的算法指导围手术期输血管理。记录输血、失血和结局数据。
两组之间在红细胞悬液单位消耗量、失血量、因出血再次手术以及早期临床结局方面无差异。与另一组相比，TEG组患者新鲜冰冻血浆和血小板的中位数单位显著更低（p = 0.001）。与另一组相比，TEG组输注的全异体单位（红细胞悬液和血液制品）总数中位数显著降低（分别为中位数2，范围1 - 3单位 vs. 中位数3，范围2 - 4单位，p = 0.001）。与另一组相比，TEG组氨甲环酸的使用需求显著减少（分别为10.3% vs. 19%，p = 0.007）。
我们的结果表明，常规使用kTEG指导算法可减少择期CABG患者的血液制品消耗量。将这种算法应用于这些患者的常规管理可能有助于改善临床结局，并降低CABG后输血相关并发症的潜在风险和总成本。
