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Excerpt
Method: Twenty four pts (15M/9F) scheduled for surgery on the ascending aorta and hemi-arch were enrolled in the study and randomly assigned to 2 groups (12 pts in a TEG monitored group, 12 patients in a non-TEG conventional monitored group). Informed consent was obtained from all patients. Exclusion criteria were liver dysfunction, chronic renal failure on haemodialysis, major coagulopathies, preoperative intravenous heparin infusion and/or inotropic therapy. Anaesthesiologists used transfusion guidelines for coagulation monitoring in pre- intra and the first 48h post-surgery. These guidelines were based on a TEG algorithm [2] in the TEG monitored group (packed red cells [PRC] if haematocrit < 27%; fresh frozen plasma [FFP] if R values >11 minutes; platelets [Plts] if maximum angle values < 54mm) and on local haemotransfusion guidelines in the conventional, non TEG monitored group (PRC if haematocrit <27%, FFP if prothrombin time [PT] >17 seconds and activated partial thromboplastin time [aPTT] >50 seconds). Antithrombin III (AT III) was transfused in both groups to maintain values >70%. Data were expressed as mean values ± standard deviation (SD). Variables were compared by Student's t-test, two-tailed. P < 0.05 was considered statistically significant.
Results: Results are reported in Table 1.
In the TEG group, platelets were transfused in only 1 patient (8.3%) whereas in the non TEG group 7 patients (58.3%) received platelets (P < 0.01). There were less significant differences between groups in FFP transfusions (P < 0.05). Postoperative bleeding at 6h, 12 h and 24 h showed a slight reduction in the TEG group but the difference did not reach statistical significance, there were no differences in PRC transfusions.
Discussion: TEG is more reliable than routine haemocoagulation assessment in predicting perioperative platelet and FFP transfusion needs in surgery for ascending aorta and hemi-arch replacement.
