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

Abstract

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.