From the Literature


Published: Oct 2014

Thromboelastography is a suboptimal test for determination of the underlying cause of bleeding associated with cardiopulmonary bypass and may not predict a hypercoagulable state.
Welsh KJ, Padilla A, Dasgupta A, Nguyen AN, Wahed A
Am J Clin Pathol 2014;142:492-497.
Pub Med
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J. Stensballe


Welsh and colleagues investigated thrombelastography (TEG) and conventional coagulation tests (CCT) in 67 retrospectively studied cardiac surgery patients. They describe a very nice local coagulation-based haemotherapy (CBH) service run by the department of pathology. The CBH service provides intra- and postoperative assessment of coagulopathy and haemotherapy based on predefined algorithms. The collected patients were treated in agreement with the CBH service.

In this small study, the authors focus on 21 out of 67 patients with ongoing postoperative bleeding that was they clinically related to coagulopathy. Allegedly, they excluded definite surgical sources of bleeding but omitted to define this. All patients had a least one abnormal CCT, six patients had abnormal TEG, and the authors found no relation with the cause of coagulopathic bleeding. However, all patients stopped bleeding.

The limitations to this study are severe and important, more than just the retrospective design, small sample size, selection bias and omissin of the the effect of antiplatelet agents. This study is not descriptive since the authors intervene based on values, and the design can only be used to conclude that control of coagulopathic bleeding is achieved by their algorithm. This conclusion is supported by the UK National Institute for Health and Care Excellence (NICE) recommendations supporting the use of TEG/ROTEM in heart surgery.

- Jakob Stensballe

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