Thromboelastogram fails to predict postoperative hemorrhage in cardiac patients

doi:10.1016/0003-4975(92)90264-5

The Annals of Thoracic Surgery

Volume 53, Issue 3, March 1992, Pages 435-439

https://doi.org/10.1016/0003-4975(92)90264-5 Get rights and content

Abstract

To determine the clinical usefulness of the thromboelastogram in the prediction of postoperative hemorrhage ir cardiac patients, we related the results of routine coagulation tests (RCTs) and thromboelastography with the amount of chest tube drainage postoperatively in 101 patients requiring cardiopulmonary bypass. Our data indicated that there was no correlation between RCT results and thromboelastographic variables. No single variable of RCTs and thromboelastography correlated well with the amount of chest tube drainage postoperatively. Before the onset of cardiopulmonary bypass, the most frequent abnormalities detected by thromboelastograms were fibrinolysis and hypocoagulability resulting from factor deficiency. Hypercoagulability detected by thromboelastograms occurred in 13% of patients after cardiopulmonary bypass and usually was not detected by RCTs. The incidence of false-negative thromboelastograms and RCT results in patients who had excessive hemorrhage of unknown cause was 46% and 52%, respectively. The incidence of fibrinolysis as detected by thromboelastograms was similar before and after bypass, but only 2 of the 18 patients with fibrinolysis had excessive hemorrhage postoperatively. Our results indicate that neither RCTs nor thromboelastography predicts the likelihood of excessive hemorrhage in patients after cardiopulmonary bypass. The thromboelastographic results should be interpreted cautiously because of the high rate of unreliable results.

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Observational prospective study using a historic control.
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Patients undergoing cardiac surgery during 2008 (n = 811) were compared with similar patients in 2009 (n = 865).
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Original articleThromboelastogram fails to predict postoperative hemorrhage in cardiac patients

Abstract

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Am J Cardiol

The hemostatic mechanism after open-heart surgery. I. Studies on plasma coagulation factors and fibrinolysis in 512 patients after extracorporeal circulation

J Thorac Cardiovasc Surg

Hemostasis defects associated with cardiac surgery, prosthetic devices, and other extracorporeal circuits

Semin Thromb Hemos

Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation

Anesth Analg

Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies

J Clin Monit

A comparison of intraoperative measurements of coagulation

Anesth Analg (Cleve)

Original article
Thromboelastogram fails to predict postoperative hemorrhage in cardiac patients