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Thromboelastography‐guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis
Author(s): ,
João D. Dias
Affiliations:
Haemonetics S.A., Signy, Switzerland
,
Angela Sauaia
Affiliations:
Department of Health Systems Management and Policy, University of Colorado Denver, Denver
,
Hardean E. Achneck
Affiliations:
Haemonetics Corporation, Braintree
,
Jan Hartmann
Affiliations:
Haemonetics Corporation, Braintree
Ernest E. Moore
Affiliations:
Department of Surgery, University of Colorado Denver, Denver
Correspondence:|Ernest E. Moore, Department of Surgery, University of Colorado Denver, Denver, CO.|Email: Ernest.Moore@dhha.org
ISTH Academy. E. Moore C.
May 31, 2019; 273623
Correspondence:|Ernest E. Moore
Correspondence:|Ernest  E. Moore
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Journal Abstract
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Background
Thromboelastography (TEG 5000 and 6s Thrombelastograph Hemostasis Analyzer; Haemonetics) is a point‐of‐care system designed to monitor and analyze the entire coagulation process in real time. TEG‐guided therapy has been shown to be valuable in a variety of surgical settings.
Objective
To conduct an analysis of published clinical trials to evaluate the effects of TEG‐guided transfusion for the management of perioperative bleeding on patient outcomes.
Patients/Methods
We searched MEDLINE (PubMed) and EMBASE for original articles reporting studies using TEG vs controls in a perioperative setting for inclusion in this systematic review. We identified nine eligible randomized controlled trials (RCTs) in two elective surgery settings (cardiac surgery and liver surgery), but only one RCT in the emergency setting.
Results
In the elective surgery study meta‐analysis, platelet (P = 0.004), plasma (P < 0.001) and red blood cell transfusion (P = 0.14), operating room length of stay (LoS) (P = 0.005), intensive care unit LoS (P = 0.04) and bleeding rate (P = 0.002) were reduced with TEG‐guided transfusion vs controls. Although blood product use was reduced, rates of mortality remained comparable between the TEG group and control group. In the emergency setting evaluation, the RCT reported lower mortality in the TEG group than in the control group (P = 0.049). In addition, there were significant reductions in platelet and plasma transfusion (P = 0.04 and P = 0.02, respectively), and the number of ventilator‐free days increased, in the TEG group as compared with the control group (P = 0.10).
Conclusions
This systematic review and analysis indicate that TEG‐guided hemostatic therapy can enhance blood product management and improve key patient outcomes, including LoS, bleeding rate, and mortality.
Keyword(s)
blood coagulation, cardiovascular surgical procedures, elective surgical procedures, emergency treatment, thromboelastography
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