Sun Wenyu, Jeleniowski Ken, Zhao Xin, Shen Peter, Li Dadong, Hammond Jonathan A
J Card Surg. 2014 Mar;29(2):238-43. doi: 10.1111/jocs.12302.
Multiple blood products are often required during and after ventricular assist device (VAD) implants. Generally, transfusion therapy is empirically guided by conventional laboratory tests. In this study, we aimed to compare a thromboelastography (TEG)-based algorithm with a laboratory coagulation test-based algorithm with respect to blood product utilization in patients undergoing VAD implant.
From June 2010 to May 2012, a total of 39 consecutive patients underwent VAD implantation. Patients undergoing VAD implant were retrospectively divided into two groups according to transfusion strategy. In the control group (n=20), the need for blood transfusion was based on clinician's discretion according to standard coagulation test results. In the TEG group (n=19), a strict protocol based on TEG parameters was followed for the usage of all perioperative blood products. Coagulation factors, TEG parameters, and blood transfusions were documented and compared between these two groups.
There were no differences in demographic variables with the exception of a decreased CPB time in the TEG group (p=0.019). Prothrombin time (PT) (p<0.001) and international normalized ratio (INR) (p<0.001) in the postprotamine interval were significantly higher in the TEG group than in the control group. No significant difference was detected in any coagulation variable in the postoperative (ICU) period between the two groups. Platelet counts decreased in a linear fashion from baseline to the postoperative period in the two groups (p<0.001). Patients in the TEG group received significantly less fresh-frozen plasma in both the intraoperative (p=0.005) and postoperative (p=0.014) periods. Patients in the TEG group also received significantly less platelets both in the postoperative (p=0.03) period and in total amount (p=0.033). There was no difference in consumption of packed red blood cell units between the two groups.
Our results show that the strict use of a TEG-guided algorithm significantly reduces the consumption of blood products in patients undergoing VAD implant
在心室辅助装置（VAD）植入期间及之后通常需要多种血液制品。一般来说，输血治疗是根据传统实验室检查凭经验指导的。在本研究中，我们旨在比较基于血栓弹力图（TEG）的算法与基于实验室凝血试验的算法在VAD植入患者血液制品使用方面的情况。
2010年6月至2012年5月，共有39例连续患者接受了VAD植入。根据输血策略，将接受VAD植入的患者回顾性分为两组。在对照组（n = 20）中，输血需求基于临床医生根据标准凝血试验结果的判断。在TEG组（n = 19）中，所有围手术期血液制品的使用遵循基于TEG参数的严格方案。记录并比较两组之间的凝血因子、TEG参数和输血情况。
除TEG组体外循环时间缩短外（p = 0.019），两组人口统计学变量无差异。TEG组鱼精蛋白注射后间隔期的凝血酶原时间（PT）（p < 0.001）和国际标准化比值（INR）（p < 0.001）显著高于对照组。两组术后（重症监护病房）期间的任何凝血变量均未检测到显著差异。两组血小板计数从基线到术后呈线性下降（p < 0.001）。TEG组患者在术中（p = 0.005）和术后（p = 0.014）期间接受的新鲜冰冻血浆显著较少。TEG组患者在术后（p = 0.03）期间以及总量（p = 0.033）方面接受的血小板也显著较少。两组之间红细胞悬液单位的消耗量无差异。
我们的结果表明，严格使用TEG指导的算法可显著减少VAD植入患者的血液制品消耗量
