Background: Viscoelastic tests (rotational thromboelastometry, ROTEM ), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.

Aims: Demonstrate that the implementation of viscoelastic tests, such as the case of ROTEM ®, allows a more selective and efficient transfusion therapy, achieving an improvement in health outcomes.

Methods: ​​​​Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM implementation.

Results: Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p=0.026) during the perioperative period. In the group monitored with ROTEM , decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p=0.002), fresh frozen plasma (9.8% vs 3.8%, p=0.008), prothrombin complex concentrate administration (0.9% vs 0.3%, p=0.599) and activated recombinant factor VII (0.3% vs 0.0%, p=0.603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p=0,530) and fibrinogen concentrate (0.9% vs 3.5%, p=0.066), tranexamic acid (0.0% vs 0.6%, p=0.370) and protamine administration (0.6% vs 0.9%, p=0.908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p=0.813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p=0.037), surgical reexploration (6.0% vs 2.9%, p=0.035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p=0.026).

Conclusions: The monitoring of hemostasis by ROTEM in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/coagulation-management-strategies-in-cardiac-surgery-viscoelastic-tests/