Abstract
Postoperative hemorrhage in patients undergoing open-heart surgery is a major cause of morbidity and mortality. Monitoring of coagulation in these patients has routinely involved the activated clotting time. Thromboelastography is currently used as a monitor of coagulation during liver transplantation. The thromboelastogram, by providing information on the interaction of all the coagulation precursors, gives more clinically useful information on coagulation than that available from the coagulation profile or the activated clotting time alone. This study was done to assess the usefulness of thromboelastography in open-heart surgery. Thirty-eight patients (29 undergoing coronary artery bypass grafting and 9 undergoing valve replacement) were studied with activated clotting time, thromboelastography, and coagulation profiles during three periods: before bypass, during bypass, and after protamine administration. Thromboelastography was a significantly better predictor (87% accuracy) of postoperative hemorrhage and need for reoperation than was the activated clotting time (30%) or coagulation profile (51%). Thromboelastography is easy to use and provides diagnostic data within 30 minutes of blood sampling.
Similar content being viewed by others
References
Ionescu MI. Techniques in extracorporeal circulation. London: Butterworths, 1981
Salzman G, Britton AFH. Hemorrhage and thrombosis. Boston: Little, Brown, 1965
Hennessy VL, Hicks RE, Niewiarowski S, et al. Function of human platelets during extracorporeal circulation. Am J Physiol 1977;232:626–628
Kang YG, Maritu D, Marquez J, et al. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation. Anesth Analg 1985;64:888–897
Hartert H. Blutgerinnungstudien mit der Thrombelastographic, einen neven Untersuchungsverfahren. Klin Wochenschr 1948;16:257
Howland W, Schweizer O, Gould P. A comparison of intraoperative measurements of coagulation. Anesth Analg 1974;53:657–663
Zuckerman L, Cohen E, Vagher J, et al. Comparison of thromboelastography with common coagulation tests. Thromb Haemost 1981;46:752–756
Von Kaulla K, Von Kaulla E, Wasantapruck S, et al. Blood coagulation in uremic patients before and after hemodialysis and transplantation of the kidney. Arch Surg 1966;92:184–191
Lee BK, Taha S, Trainor F, et al. Monitoring heparin therapy with thrombelastography and activated partial thromboplastin time. World J Surg 1980;4:323–330
Saleem A, Blifeld C, Salwa S, et al. Viscoelastic measurement of clot formation: a new test of platelet function. Ann Clin Lab Sci 1983;12:115–124
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Spiess, B.D., Tuman, K.J., McCarthy, R.J. et al. Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies. J Clin Monitor Comput 3, 25–30 (1987). https://doi.org/10.1007/BF00770880
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00770880