Department of Anesthesia and Intensive Care Medicine, University Hospital, Basel, Switzerland.
Transfus Med Rev. 2013 Oct;27(4):213-20. doi: 10.1016/j.tmrv.2013.08.004. Epub 2013 Sep 26.
The value of thrombelastography (TEG) and thromboelastometry (ROTEM) to improve perioperative hemostasis is under debate. We aimed to assess the effects of TEG- or ROTEM-guided therapy in patients undergoing cardiac surgery on the use of allogeneic blood products. We analyzed 12 trials including 6835 patients, 749 of them included in 7 randomized controlled trials (RCTs). We collected data on the amount of transfused allogeneic blood products and on the proportion of patients who received allogeneic blood products or coagulation factor concentrates. Including all trials, the odds ratios (ORs) for transfusion of red blood cell (RBC) concentrates, fresh-frozen plasma (FFP), and platelets were 0.62 (95% confidence interval [CI], 0.56-0.69; P<.001), 0.28 (95% CI, 0.24-0.33; P<.001), and 0.55 (95% CI, 0.49-0.62; P<.001), respectively. However, more than 50% of the patients in this analysis were derived from one retrospective study. Including RCTs only, the ORs for transfusion of RBC, FFP, and platelets were 0.54 (95% CI, 0.38-0.77; P<.001), 0.36 (95% CI, 0.25-0.53; P<.001), and 0.57 (95% CI, 0.39-0.81; P=.002), respectively. The use of coagulation factor concentrates was reported in 6 studies, 2 of them were RCTs. The ORs for the infusion of fibrinogen and prothrombin complex concentrate were 1.56 (95% CI, 1.29-1.87; P<.001) and 1.74 (95% CI, 1.40-2.18; P<.001), respectively. However, frequencies and amounts were similar in the intervention and control group in the 2 RCTs. It is presumed that TEG- or ROTEM-guided hemostatic management reduces the proportion of patients undergoing cardiac surgery transfused with RBC, FFP, and platelets. This presumption is strongly supported by similar ORs found in the analysis including RCTs only. Patient blood management based on the transfusion triggers by TEG or ROTEM appears to be more restrictive than the one based on conventional laboratory testing. However, evidence for improved clinical outcome is limited at this time.
血栓弹力描记术（TEG）和血栓弹力图（ROTEM）在改善围手术期止血方面的价值仍存在争议。我们旨在评估 TEG 或 ROTEM 指导治疗对接受心脏手术患者的异体血液制品使用的影响。我们分析了 12 项试验，包括 6835 例患者，其中 749 例患者纳入了 7 项随机对照试验（RCT）。我们收集了输注异体血液制品的数量和接受异体血液制品或凝血因子浓缩物的患者比例的数据。包括所有试验在内，红细胞（RBC）浓缩液、新鲜冷冻血浆（FFP）和血小板输注的优势比（OR）分别为 0.62（95%置信区间[CI]，0.56-0.69；P<.001）、0.28（95%CI，0.24-0.33；P<.001）和 0.55（95%CI，0.49-0.62；P<.001）。然而，本分析中超过 50%的患者来自一项回顾性研究。仅包括 RCT 时，RBC、FFP 和血小板输注的 OR 分别为 0.54（95%CI，0.38-0.77；P<.001）、0.36（95%CI，0.25-0.53；P<.001）和 0.57（95%CI，0.39-0.81；P=.002）。有 6 项研究报告了凝血因子浓缩物的使用情况，其中 2 项为 RCT。纤维蛋白原和凝血酶原复合物浓缩物输注的 OR 分别为 1.56（95%CI，1.29-1.87；P<.001）和 1.74（95%CI，1.40-2.18；P<.001）。然而，在这 2 项 RCT 中，干预组和对照组的输注频率和剂量相似。据推测，TEG 或 ROTEM 指导的止血管理可降低接受心脏手术患者输注 RBC、FFP 和血小板的比例。这一推测得到了仅包括 RCT 分析中发现的相似 OR 的有力支持。基于 TEG 或 ROTEM 的输血触发的患者血液管理似乎比基于常规实验室检测的输血触发更具限制性。然而，目前改善临床结局的证据有限。
