ORIGINAL ARTICLE   Free

Minerva Anestesiologica 2019 May;85(5):505-13

DOI: 10.23736/S0375-9393.18.12960-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

The velocity curve of the clotting waveform of rotational thromboelastometry predicts bleeding after cardiac surgery but conventional rotational thromboelastometric parameters do not

Karam NAM, Yunseok JEON, Tae K. KIM, Woo Y. JO, Sehee YOON, Jooah KWAK, Youn J. CHO ✉

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea

BACKGROUND: Early detection of a risk of postoperative bleeding is essential in cardiac surgery patients. The aim of the present study was to evaluate the utility of the first derivative curve (the V-curve) of the clotting waveform of rotational thromboelastometry (ROTEM) in terms of predicting bleeding after cardiac surgery.
METHODS: We retrospectively analysed 534 cardiac surgery patients. We used the chest tube output during the stay in the intensive care unit to divide patients into a higher blood loss group (HBL group; the fourth quartile) and a lower blood loss group (LBL group; the lower quartiles). We performed multivariable logistic regression using the V-curve parameters and potential confounders including conventional ROTEM parameters.
RESULTS: In the multivariable model, the adjusted odds ratios for HBL of patients with a lower maximum clotting velocity (MaxVel ≤9 mm*100 s-1) as revealed by extrinsically activated ROTEM (EXTEM), and the area under the velocity curve (AUC ≤988 mm*100) of the fibrin-based extrinsically activated ROTEM (FIBTEM), both measured at skin closure in the end of surgery, were 1.78 (95% CI 1.03 to 3.07) and 2.14 (95% CI 1.20 to 3.82), respectively. However, conventional ROTEM parameters were not included in the final model. Additionally, lower EXTEM MaxVel and FIBTEM AUC values were associated with the need for a higher transfusion volume, longer postoperative intensive care unit and hospital stays, and more frequent re-exploration to control bleeding.
CONCLUSIONS: The ROTEM V-curve parameters can predict postoperative bleeding and clinical outcomes after cardiac surgery.

KEY WORDS: Blood coagulation; Cardiac surgical procedures; Point-of-care testing; Postoperative hemorrhage; Thromboelastography