Prediction of bleeding diathesis in patients undergoing cardiopulmonary bypass during cardiac surgery

Viscoelastic measures versus routine coagulation test

Ruoh Lan Shih, Yih Giun Cherng, Anne Chao, Jui Tai Chen, Ai Li Tsai, Chien Chiang Liu

研究成果: 雜誌貢獻文章

33 引文 (Scopus)

摘要

Background: Severe hemorrhagic tendency often complicates cardiopulmonary bypass (CPB) in cardiac surgery. In this study, we compared the effectiveness of thromboelastography (TEG), Sonoclot (SCT), and routine coagulation test (RCT) in the prediction of coagulation defects. Methods : Forty-three patients undergoing cardiac surgery with CPB were included. Blood for RCT, TEG, and SCT profiles was sampled before systemic heparinization and after protamine administration. Clinically significant bleeding was defined as chest tube drainage in excess of 100 ml/h for 3 consecutive hours or 300 ml/h in 1 h. All coagulation parameters obtained before and after CPB w ere compared. The sensitivity, specificity, accuracy, false positive, and false negative rate were also calculated and compared. Results : All coagulation tests were within normal range except higher partial thromboplastin time. Variables which were significantly different from those before CPB included platelet count, fibrinogen level, prothrombin time, and thrombin time in RCT, a angle and maximum amplitude in TEG, and R 2 and peak time in SCT. In the TEG tracing, all variables had high sensitivity, specificity, and accuracy (average 85.4%, 83%, and 83.5% respectively) and low false positive and negative rate (12.5% and 5% respectively). Although SCT had high sensitivity (76.3%) and low false negative rate (6.5%), its specificity and accuracy were all under 50%. Conclusions : Our data demonstrated that the TEG monitoring is a useful tool for detecting post-CPB bleeding diathesis and can provide much predictive information. RCT and SCT are of limited value because of higher rate of unreliable results.
原文英語
頁(從 - 到)133-139
頁數7
期刊Acta Anaesthesiologica Sinica
35
發行號3
出版狀態已發佈 - 1997
對外發佈Yes

指紋

Thrombelastography
Disease Susceptibility
Cardiopulmonary Bypass
Thoracic Surgery
Hemorrhage
Blood Coagulation Tests
Thrombin Time
Sensitivity and Specificity
Chest Tubes
Protamines
Partial Thromboplastin Time
Prothrombin Time
Platelet Count
Fibrinogen
Drainage
Reference Values

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

引用此文

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title = "Prediction of bleeding diathesis in patients undergoing cardiopulmonary bypass during cardiac surgery: Viscoelastic measures versus routine coagulation test",
abstract = "Background: Severe hemorrhagic tendency often complicates cardiopulmonary bypass (CPB) in cardiac surgery. In this study, we compared the effectiveness of thromboelastography (TEG), Sonoclot (SCT), and routine coagulation test (RCT) in the prediction of coagulation defects. Methods : Forty-three patients undergoing cardiac surgery with CPB were included. Blood for RCT, TEG, and SCT profiles was sampled before systemic heparinization and after protamine administration. Clinically significant bleeding was defined as chest tube drainage in excess of 100 ml/h for 3 consecutive hours or 300 ml/h in 1 h. All coagulation parameters obtained before and after CPB w ere compared. The sensitivity, specificity, accuracy, false positive, and false negative rate were also calculated and compared. Results : All coagulation tests were within normal range except higher partial thromboplastin time. Variables which were significantly different from those before CPB included platelet count, fibrinogen level, prothrombin time, and thrombin time in RCT, a angle and maximum amplitude in TEG, and R 2 and peak time in SCT. In the TEG tracing, all variables had high sensitivity, specificity, and accuracy (average 85.4{\%}, 83{\%}, and 83.5{\%} respectively) and low false positive and negative rate (12.5{\%} and 5{\%} respectively). Although SCT had high sensitivity (76.3{\%}) and low false negative rate (6.5{\%}), its specificity and accuracy were all under 50{\%}. Conclusions : Our data demonstrated that the TEG monitoring is a useful tool for detecting post-CPB bleeding diathesis and can provide much predictive information. RCT and SCT are of limited value because of higher rate of unreliable results.",
keywords = "Blood coagulation tests: thromboelastography, Sonoclot, Surgery, cardiovascular",
author = "Shih, {Ruoh Lan} and Cherng, {Yih Giun} and Anne Chao and Chen, {Jui Tai} and Tsai, {Ai Li} and Liu, {Chien Chiang}",
year = "1997",
language = "English",
volume = "35",
pages = "133--139",
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TY - JOUR

T1 - Prediction of bleeding diathesis in patients undergoing cardiopulmonary bypass during cardiac surgery

T2 - Viscoelastic measures versus routine coagulation test

AU - Shih, Ruoh Lan

AU - Cherng, Yih Giun

AU - Chao, Anne

AU - Chen, Jui Tai

AU - Tsai, Ai Li

AU - Liu, Chien Chiang

PY - 1997

Y1 - 1997

N2 - Background: Severe hemorrhagic tendency often complicates cardiopulmonary bypass (CPB) in cardiac surgery. In this study, we compared the effectiveness of thromboelastography (TEG), Sonoclot (SCT), and routine coagulation test (RCT) in the prediction of coagulation defects. Methods : Forty-three patients undergoing cardiac surgery with CPB were included. Blood for RCT, TEG, and SCT profiles was sampled before systemic heparinization and after protamine administration. Clinically significant bleeding was defined as chest tube drainage in excess of 100 ml/h for 3 consecutive hours or 300 ml/h in 1 h. All coagulation parameters obtained before and after CPB w ere compared. The sensitivity, specificity, accuracy, false positive, and false negative rate were also calculated and compared. Results : All coagulation tests were within normal range except higher partial thromboplastin time. Variables which were significantly different from those before CPB included platelet count, fibrinogen level, prothrombin time, and thrombin time in RCT, a angle and maximum amplitude in TEG, and R 2 and peak time in SCT. In the TEG tracing, all variables had high sensitivity, specificity, and accuracy (average 85.4%, 83%, and 83.5% respectively) and low false positive and negative rate (12.5% and 5% respectively). Although SCT had high sensitivity (76.3%) and low false negative rate (6.5%), its specificity and accuracy were all under 50%. Conclusions : Our data demonstrated that the TEG monitoring is a useful tool for detecting post-CPB bleeding diathesis and can provide much predictive information. RCT and SCT are of limited value because of higher rate of unreliable results.

AB - Background: Severe hemorrhagic tendency often complicates cardiopulmonary bypass (CPB) in cardiac surgery. In this study, we compared the effectiveness of thromboelastography (TEG), Sonoclot (SCT), and routine coagulation test (RCT) in the prediction of coagulation defects. Methods : Forty-three patients undergoing cardiac surgery with CPB were included. Blood for RCT, TEG, and SCT profiles was sampled before systemic heparinization and after protamine administration. Clinically significant bleeding was defined as chest tube drainage in excess of 100 ml/h for 3 consecutive hours or 300 ml/h in 1 h. All coagulation parameters obtained before and after CPB w ere compared. The sensitivity, specificity, accuracy, false positive, and false negative rate were also calculated and compared. Results : All coagulation tests were within normal range except higher partial thromboplastin time. Variables which were significantly different from those before CPB included platelet count, fibrinogen level, prothrombin time, and thrombin time in RCT, a angle and maximum amplitude in TEG, and R 2 and peak time in SCT. In the TEG tracing, all variables had high sensitivity, specificity, and accuracy (average 85.4%, 83%, and 83.5% respectively) and low false positive and negative rate (12.5% and 5% respectively). Although SCT had high sensitivity (76.3%) and low false negative rate (6.5%), its specificity and accuracy were all under 50%. Conclusions : Our data demonstrated that the TEG monitoring is a useful tool for detecting post-CPB bleeding diathesis and can provide much predictive information. RCT and SCT are of limited value because of higher rate of unreliable results.

KW - Blood coagulation tests: thromboelastography, Sonoclot

KW - Surgery, cardiovascular

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