The Predictive Value of Thrombelastography and Routine Coagulation Tests for Postoperative Blood Loss in Open Heart Surgery

Introduction. Hemorrhage after cardiopulmonary bypass remains a clinical problem. Aim of the Study. Study was performed to compare efficacy of trombelastography (TEG) and routine coagulation tests in relation for postoperative bleeding after cardiac surgery in CPB. Materials and methods. Forty-seven adult cardiac surgical patients were enrolled in prospective study at Pauls Stradins Clinical University Hospital in 2010. Blood samples for prothrombin time, international normalized ratio, activated partial thromboplastin time (APTT), fibrinogen level, platelet count were collected before surgery, at admission in intensive care unit (ICU) and 6, 12 hours after operation. Before induction of general anesthesia blood sample was collected to perform kaolin activated TEG (kTEG) and at admission in ICU - kTEG and heparinase- modified kTEG. Results. Correlation postoperatively was between kTEG reaction time (R) and APTT, as well as heparinase-modified kTEG maximum amplitude (MA) and platelet count. Significant correlation with postoperative bleeding showed heparinase-modified kTEG MA on admission to the ICU. The highest predictive value preoperatively showed kTEG alpha angle (A), APTT, platelet count and postoperatively kTEG MA, APTT on admission to ICU. Conclusions. Associated with bleeding are following TEG variables: preoperatively kTEG A, postoperatively kTEG MA and heparinase-modified kTEG MA. APTT and platelet count are also related to postoperative bleeding but to a lesser degree.