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Comparative Study
. 2018 Apr-Jun;21(2):151-157.
doi: 10.4103/aca.ACA_174_17.

Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery

Seema Sharma  1 , Sujeet Kumar  1 , Prabhat Tewari  2 , Shantanu Pande  3 , Manjula Murari  1
Affiliations
Comparative Study

Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery

Seema Sharma et al. Ann Card Anaesth. 2018 Apr-Jun.

Abstract

Introduction: Peri-operative monitoring of coagulation is important to diagnose potential cause of hemorrhage, to manage coagulopathy and guide treatment with blood products in patients undergoing cardiac surgery with cardiopulmonary bypass. This study was done to evaluate usefulness of Thromboelastography (TEG) and routine coagulation tests (RCT) in assessing hemostatic changes and predicting postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: Fifty adult patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled in this prospective study. Preoperative and post-operative samples were collected for routine coagulation tests and TEG. Regression analysis and test of significance using Pearson's correlation coefficient was performed to assess correlation between routine coagulation tests and corresponding TEG parameters .Regression analysis was done to study relation between blood loss at 24 hours and various coagulation parameters.

Results:: The Routine coagulation test i.e. PT, INR, APTT showed no significant correlation with corresponding TEG parameters in pre-operative samples. However platelet count significantly correlated (p = 0.004) with MA values in postoperative samples. A significant correlation (p = 0.001) was seen between fibrinogen levels and alpha angles as well as with MA in both baseline preoperative and postoperative samples. TEG parameters R time and MA in postoperative samples were the only parameters that predicted bleeders with fair accuracy.

Conclusion: Though the techniques of RCT and TEG are different, a few RCT e.g. platelet count and fibrinogen correlated with corresponding TEG parameters i.e. MA and Alpha angle. TEG parameters (R time and MA in postoperative samples) were able to predict blood loss better than RCT.

Keywords: Cardiopulmonary bypass; routine coagulation tests; thromboelastography.

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Conflict of interest statement

It has been partially presented as: 1. "Correlation of TEG parameters with routine coagulation tests in patients undergoing cardiac bypass surgery" in ISLH 2016, and has been abstracted in International Journal of Laboratory Hematology, Volume 38, Issue S2, May 2016, Page 96. 2. "Utility of thromboelastography (TEG) and routine coagulation tests to predict postoperative bleeding in cardiac surgery with cardiopulmonary bypass" in ILSH 2017 has been abstracted in International Journal Of Laboratory Hematology, Volume 39, Issue S2, May 2017, Page 106.

Figures

Figure 1
Figure 1
(a) Correlation between thromboelastography and routine coagulation tests parameters. (b) Correlation between thromboelastography parameters and blood loss. (c) Receivers operating characteristic curves for predicting bleeders
See this image and copyright information in PMC

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