Evaluation of a novel transfusion algorithm employing point-of-care coagulation assays in cardiac surgery: a retrospective cohort study with interrupted time-series analysis.

Karkouti K, McCluskey SA, Callum J, et al.
Anesthesiology 2015;122:560-570.
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Review by : J.-F. Hardy
NATA Review

The authors evaluated a novel transfusion algorithm that uses point-of-care coagulation testing. They enrolled consecutive patients who underwent cardiac surgery with bypass at one hospital before (January 1, 2012 to January 6, 2013) and after (January 7, 2013 to December 13, 2013). Institution of the ROTEM-based algorithm was associated with reduced transfusion.

Despite being of interest, the authors’ findings are not unexpected. All similar studies introducing some form of transfusion algorithm have been successful in the past. Some were based on conventional coagulation tests (PT, aPTT, platelet count) and others on point-of-care coagulation monitoring. It seems that whenever clinicians think about what they are doing and attempt to justify the indication for a blood product (as opposed to a knee-jerk type transfusion reflex) they are able to contain/decrease transfusions with equally good results.

So, while an algorithm per se (and clinician thoughtfulness) is a good thing, only a randomised clinical trial comparing two strategies head-to-head will be able to determine how a ROTEM-based algorithm compares to other approaches.

– Jean-Fran├žois Hardy

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