Article description

Summary:

This prospective observational study examined whether standard coagulation tests or Thromboelastography (TEG) can reliably predict clinically significant microvascular bleeding following cardiopulmonary bypass (CPB) in adult cardiac surgery patients.

• The study included 816 patients undergoing elective cardiac surgery, of whom 358 (44%) experienced microvascular bleeding and 458 (56%) did not. Microvascular bleeding was defined as clinically significant non-surgical bleeding, ten minutes after CPB, determined by a consensus between the surgeon and anesthesiologist.
• Among standard coagulation tests, prothrombin time (PT) showed 62% accuracy (51% sensitivity, 70% specificity), international normalized ratio (INR) also had 62% accuracy (48% sensitivity, 72% specificity), and platelet count showed 62% accuracy (62% sensitivity, 61% specificity).
• TEG parameters performed poorly, with an average sensitivity of 0.55, a specificity of 0.59, and an accuracy of 0.57 in predicting microvascular bleeding.
• Patients with microvascular bleeding had significantly worse secondary outcomes, including higher chest tube output, increased RBC transfusion requirements, greater reoperation rates, higher 30-day readmission rates, and increased in-hospital mortality.

Conclusions:

Neither standard coagulation tests nor TEG parameters were able to reliably predict clinically significant microvascular bleeding following CPB. These findings highlight the limited utility of current coagulation tests in guiding post-CPB bleeding risk assessment, as both modalities showed poor agreement with expert clinical judgment.