WASHINGTON — Monitoring hemostasis with thromboelastography was associated with reduced bleeding and blood product use in infants undergoing open-heart surgery in a nonrandomized comparison of 182 patients at one center.
“TEG [thromboelastography]-guided treatment is specific to a patient's hemostasis profile and allows correction of coagulopathy before the patient leaves the operative room,” Dr. Eric Mendeloff said at the annual meeting of the American Association of Thoracic Surgery.
TEG provides a global assessment of hemostasis. Rather than measure the serum level of various clotting factors, it measures parameters such as the rate of clot formation and clot strength. The TEG device is Food and Drug Administration approved, and is marketed by Haemoscope. Dr. Mendeloff's study received no commercial funding, and he disclosed no financial relationships.
The study assessed blood product use in infants less than 6 months old who underwent cardiopulmonary bypass for open-heart surgery at Medical City during two eras of TEG use. The study included 70 babies who had surgery during November 2003-January 2005, when the TEG monitor was not available. A second set of 112 infants underwent surgery during April 2005-January 2007, when TEG monitoring was used routinely at the hospital.
The average age of the children in each group was 3 months, and the two groups did not differ by weight, bypass time, or degree of hypothermia. The two groups also had similar lab values before surgery and a similar level of aspirin use.
Because cyanotic infants bleed more than acyanotic babies, the analysis also examined the impact of TEG among infants in each of these subgroups. In the pre-TEG era, 19% of the infants were cyanotic; in the TEG era, 41% were cyanotic.
Among all patients, those treated using TEG had significantly less total blood product use postoperatively, compared with patients treated before TEG. The blood products measured were fresh-frozen plasma, cryoprecipitate, platelets, and packed red cells. TEG use led to significant increases in the volume of fresh frozen plasma used both intraoperatively and postoperatively, but this effect was more than counterbalanced by increased use of cryoprecipitate and platelets during the pre-TEG era. Use of TEG was also linked with a significant reduction in the volume of fluid removed by the chest tube, measured at 1, 2, and 24 hours following surgery.
In the acyanotic patients, TEG use was also linked with a significant reduction in the total volume of blood products infused, and with a reduction in the volume of fluid removed by the chest tube postoperatively. In contrast, in cyanotic patients, TEG use was linked with an increased volume of blood products, which was caused by a substantially increased need for fresh-frozen plasma in the TEG group. Despite the increased use of fresh-frozen plasma, chest tube volume was less with TEG monitoring at all time points measured.
“TEG was equally effective for correcting hemostasis in the cyanotic and acyanotic patients,” said Dr. Mendeloff, who is surgical director of the congenital heart disease program at Medical City Hospital in Dallas.