Thromboelastography (TEG)-Based Algorithm Reduces Blood Product Utilization in Patients undergoing VAD Implant

OBJECTIVES:

Multiple blood products are often
required during and after ventricular assist device (VAD) implants.
Generally, transfusion therapy is empirically guided by conventional
laboratory tests. In this study, we aimed to compare a
thromboelastography (TEG)-based algorithm with a laboratory coagulation
test-based algorithm with respect to blood product utilization in
patients undergoing VAD implant.

METHODS:

From June 2010
to May 2012, a total of 39 consecutive patients underwent VAD
implantation. Patients undergoing VAD implant were retrospectively
divided into two groups according to transfusion strategy. In the
control group (n=20), the need for blood transfusion was based on
clinician’s discretion according to standard coagulation test results.
In the TEG group (n=19), a strict protocol based on TEG parameters was
followed for the usage of all perioperative blood products. Coagulation
factors, TEG parameters, and blood transfusions were documented and
compared between these two groups.

RESULTS:

There were no
differences in demographic variables with the exception of a decreased
CPB time in the TEG group (p=0.019). Prothrombin time (PT) (p<0.001) and international normalized ratio (INR) (p<0.001) in the postprotamine interval were significantly higher in the TEG group than in the control group. No significant difference was detected in any coagulation variable in the postoperative (ICU) period between the two groups. Platelet counts decreased in a linear fashion from baseline to the postoperative period in the two groups (p<0.001). Patients in the TEG group received significantly less fresh-frozen plasma in both the intraoperative (p=0.005) and postoperative (p=0.014) periods. Patients in the TEG group also received significantly less platelets both in the postoperative (p=0.03) period and in total amount (p=0.033). There was no difference in consumption of packed red blood cell units between the two groups.

CONCLUSIONS:

Our results show that the strict
use of a TEG-guided algorithm significantly reduces the consumption of
blood products in patients undergoing VAD implant