J. Parreco1, M. Eby1, A. A. Kurian1, C. Faber1, R. Kozol1 1University Of Miami,Miami, FL, USA
Introduction:
Thromboelastography (TEG) has been used since the 1940s and the first use in cardiac surgery was reported in the 1980s. The purpose of this meta-analysis was to evaluate and compare the results of implementing TEG in the routine monitoring for postoperative bleeding after cardiac surgery.
Methods:
Studies involving TEG and cardiac surgery were systematically reviewed. Studies comparing TEG to conventional assessments were included in this meta-analysis and analyzed using random or fixed effect models to determine the mean difference or odds ratio.
Results:
Six studies were identified and included 1,770 patients undergoing cardiac surgery. This included 880 patients having TEG testing performed and 890 control patients without TEG testing performed. The patients undergoing the TEG assay were less likely to require transfusions of red blood cells (RBC), plasma or platelets. For these transfusions the odds ratios (OR) with confidence interval (CI) were: 0.58 (95% CI 0.46 to 0.73, p<0.01) for RBC, 0.57 (95% CI 0.45 to 0.72, p<0.01) for plasma and 0.60 (95% CI 0.48 to 0.74, p<0.01) for platelets. The number of patients requiring reexploration for bleeding was also less in the patients having TEG testing with an OR of 0.38 (95% CI 0.22 to 0.67, p<0.01). The chest tube drainage amounts were also less in the TEG patients with a mean difference (MD) of -450.1 (95% CI -875.5 to -24.7, p=0.04).
Conclusion:
Transfusion requirements for patients undergoing cardiac surgery with TEG testing were significantly less than patients undergoing conventional assessments for postoperative hemorrhage. The rate of reexploration and chest tube drainage was also significantly less for patients undergoing TEG testing.
