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Rotational Thromboelastometry Predicts Increased Bleeding After Off-Pump Coronary Bypass Surgery

 Sarah Soh  ;  Young-Lan Kwak  ;  Jong-Wook Song  ;  Kyung-Jong Yoo  ;  Hee-Jung Kim  ;  Jae-Kwang Shim 
 Annals of Thoracic Surgery, Vol.104(4) : 1318-1324, 2017 
Journal Title
 Annals of Thoracic Surgery 
Issue Date
Aged ; Algorithms ; Blood Coagulation Disorders/complications ; Blood Coagulation Disorders/diagnosis* ; Blood Loss, Surgical* ; Blood Transfusion* ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Female ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage*/etiology ; Postoperative Hemorrhage*/therapy ; Retrospective Studies ; Thrombelastography*
BACKGROUND: We aimed to investigate the ability of rotational thromboelastometry (ROTEM) thresholds for coagulopathy to predict increased perioperative blood loss in off-pump coronary artery bypass graft surgery (OPCABG) and its association with transfusion requirement. METHODS: The data of 303 patients undergoing OPCABG were retrospectively analyzed. Perioperative blood loss and transfusion requirement were compared according to the presence of abnormal ROTEM thresholds, which were tested after anesthesia induction and heparin reversal. Logistic regression analyses were performed to predict significant perioperative blood loss (more than 20% of estimated blood volume). RESULTS: After graft completion, 92 patients (30%) exhibited abnormal ROTEM thresholds and showed significantly higher perioperative blood loss (median 840 mL [interquartile range: 646 to 1,102 mL] versus median 690 [interquartile range: 530 to 850 mL], p < 0.001) and greater transfusion requirement (both in the number of patients receiving transfusion and the median number of transfused units) of packed erythrocytes and fresh frozen plasma than patients exhibiting no ROTEM thresholds. After multivariate analysis of preoperative anemia, postoperative international normalized ratio greater than 1.3, and ROTEM thresholds, only ROTEM threshold (odds ratio 3.45, 95% confidence interval: 2.00 to 5.97, p < 0.001) remained an independent predictor of significant perioperative blood loss, which occurred in 79 patients (26%). CONCLUSIONS: Abnormal ROTEM thresholds after heparin reversal were found to be associated with significant perioperative bleeding and transfusion requirement in OPCABG. Rotational thromboelastometry may allow timely hemostatic interventions to reduce blood loss and transfusion in OPCABG.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
곽영란(Kwak, Young Lan) ORCID logo https://orcid.org/0000-0002-2984-9927
소사라(Soh, Sa Rah) ORCID logo https://orcid.org/0000-0001-5022-4617
송종욱(Song, Jong Wook) ORCID logo https://orcid.org/0000-0001-7518-2070
심재광(Shim, Jae Kwang) ORCID logo https://orcid.org/0000-0001-9093-9692
유경종(Yoo, Kyung Jong) ORCID logo https://orcid.org/0000-0002-9858-140X
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