Using Thromboelastography to Predict Blood Loss After Off-Pump Coronary Artery Bypass Grafting

Yu Liu,1 Wen-Li Zhang,1 Ji-Qiang Bu,1 Jian-Jun Gu,1 Yong-Quan Sun,1 Hong-Zhan Cui,1 Da-Wei Wang,2 Zi-Ying Chen1 1Department of Cardiac Surgery, Second Hospital of Hebei Medical University, Shi Jiazhuang, 050000, People’s Republic of China; 2Department of Cardiac Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, People’s Republic of ChinaCorrespondence: Zi-Ying ChenDepartment of Cardiac Surgery, Second Hospital of Hebei Medical University, No. 215 of Heping West Road, XinHua District, Shijiazhuang, 050000, People’s Republic of ChinaTel +86 15803210520Fax +86 311 6600 2995Email chenziying258@163.comObjective: This study aims to investigate the value of thromboelastography (TEG) in predicting blood loss, and its relationship with blood transfusion demand, during the perioperative period in off-pump coronary artery bypass grafting (OPCABG).Methods: The data of 398 patients undergoing OPCABG were retrospectively analyzed. Blood was drawn before anesthesia induction (T1) and at 10 minutes after heparin neutralization (T2) for further TEG detection. The patients were divided into two groups based on the results at T2: a TEG normal group and a TEG abnormal group. Logistic regression analysis was used to predict the related factors contributing to the significant increase in perioperative blood loss (more than 20% of the estimated blood volume).Results: There were 277 (69.6%) patients in the TEG normal group and 121 (30.4%) in the TEG abnormal group. Compared with the TEG normal group, the volume of blood loss, red blood cell count, and volume of plasma transfusion in the TEG abnormal group significantly increased within 24 hours after surgery. The results of the logistic regression analysis identified the use of clopidogrel, platelet count at T2, fibrinogen level at T2, and abnormality in TEG value as independent predictors for the significant increase in perioperative blood loss (P < 0.001).Conclusion: The abnormality in TEG value after heparin neutralization is correlated with massive hemorrhage and blood transfusion during the perioperative period in OPCABG. TEG detection can assist in clinical treatment and reduce the volume of blood lost in a hemorrhage and the volume of blood required in a transfusion during OPCABG.Keywords: thromboelastography, off-pump coronary artery bypass grafting, perioperative period, blood loss, blood transfusion