Comparison of the Quantra QPlus System With Thromboelastography in Cardiac Surgery

Abstract

Objectives: Use of viscoelastic testing, such as thromboelastography (TEG), is recommended in cardiac surgery to monitor coagulation and to guide the transfusion of blood products. The Quantra QPlus System is a novel point-of-care platform that uses ultrasonic pulses to characterize dynamic changes in viscoelastic properties of a blood sample during coagulation. Despite the ability to assess similar aspects of clot formation, limited studies addressing the interchangeability of viscoelastic testing parameters exist. The primary aim of the present study was to assess the correlation and agreement between Quantra and TEG5000 results using blood samples from cardiac surgery patients.

Design: Tertiary care, academic medical center.

Setting: Prospective observational study.

Participants: Twenty-eight patients undergoing elective cardiac surgery undergoing cardiopulmonary bypass were evaluated.

Measurements and main results: Perioperative blood samples were collected and assessed using Quantra, and results were compared with TEG and conventional coagulation testing. Method comparison analysis demonstrated that Quantra parameters (Quantra clot time, clot stiffness, and fibrinogen contribution to clot stiffness) significantly correlated with TEG R and TEG G after induction of anesthesia, during cardiopulmonary bypass, and after rewarming (r_s = 0.83, r_s = 0.84, and r_s = 0.73, respectively). However, Quantra parameters demonstrated poor agreement compared with equivalent TEG5000 parameters.

Conclusions: The Quantra QPlus System significantly correlated with TEG5000, suggesting that this test may be used in a similar clinical context. Despite the strength of correlation between Quantra and TEG parameters, measurements are not interchangeable.

Keywords: cardiac surgery; cardiopulmonary bypass surgery coagulopathy; hemostasis; point-of-care testing; thromboelastography.