Predictive value of thrombelastogram on venous thromboembolism in elderly patients undergoing cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WU Juan , WU Menghan

Outpatient Department, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

WU Juan, Email: 410518200@qq.com

Keywords：

Venous thromboembolism; thrombelastogram; cardiac surgery; the elderly; treatment

DOI：

10.7507/1007-4848.201909052

Video：

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Objective To analyze the predictive value of thrombelastogram (TEG) on venous thromboembolism in elderly patients undergoing cardiac surgery.Methods A total of 64 patients with venous thromboembolism after cardiac surgery in our hospital from March 2014 to March 2018 were selected as a pathogenesis group, including 38 males and 26 females, aged 61-73 (67.3±5.8) years. And 158 patients without venous thromboembolism who underwent cardiac surgery during the same period were selected as a control group, including 82 males and 76 females, aged 59-75 (65.9±7.1) years. Routine coagulation parameters such as plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), platelet count (PLT) and various indicators of TEG were measured in two groups. The correlation analysis was performed on the obtained results, and the specificity and sensitivity of conventional coagulation indicators and TEG indicators for venous thromboembolism were analyzed and compared.Results There were significant differences between the two groups in routine coagulation parameters and TEG (P<0.05). The area under the receiver operating characteristic (ROC) curve for each indicator was >0.5, which was of diagnostic significance. When the sensitivity>90%, the highest specificity value was also selected. The sensitivity and specificity of each indicator of TEG were greater than those of conventional coagulation indicators. The reaction time (R) was positively correlated with APTT in all indicators of TEG, and coagulation speed (K) was negatively correlated with Fib and PLT. Maximum thrombus intensity (MA) and Angle were positively correlated with Fib and PLT (all P<0.05). There was no correlation between TEG indicators and D-D.Conclusion The TEG has higher predictive value for postoperative venous thromboembolism in elderly patients undergoing cardiac surgery than conventional coagulation tests. However, D-D level tests have unique diagnostic value in the diagnosis of venous thromboembolism.

Citation： WU Juan, WU Menghan. Predictive value of thrombelastogram on venous thromboembolism in elderly patients undergoing cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(7): 766-769. doi: 10.7507/1007-4848.201909052 Copy

1.	Shore-Lesserson L, Manspeizer HE, DePerio M, et al. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg, 1999, 88(2): 312-319.
2.	李金澤, 董一君, 錢永軍, 等. 心臟機械瓣膜置換術后抗凝治療遠程管理: 前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2019, 26(4): 343-347.
3.	Preisman S, Kogan A, Itzkovsky K, et al. Modified thromboelastography evaluation of platelet dysfunction in patients undergoing coronary artery surgery. Eur J Cardiothorac Surg, 2010, 37(6): 1367-1374.
4.	Weitzel NS, Weitzel LB, Epperson LE, et al. Platelet mapping as part of modified thromboelastography (TEG?) in patients undergoing cardiac surgery and cardiopulmonary bypass. Anaesthesia, 2012, 67(10): 1158-1165.
5.	Welsh KJ, Padilla A, Dasgupta A, et al. Thromboelastography is a suboptimal test for determination of the underlying cause of bleeding associated with cardiopulmonary bypass and may not predict a hypercoagulable state. Am J Clin Pathol, 2014, 142(4): 492-497.
6.	Song JG, Jeong SM, Jun IG, et al. Five-minute parameter of thromboelastometry is sufficient to detect thrombocytopenia and hypofibrinogenaemia in patients undergoing liver transplantation. Br J Anaesth, 2014, 112(2): 290-297.
7.	Sharma S, Kumar S, Tewari P, et al. Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery. Ann Card Anaesth, 2018, 21(2): 151-157.
8.	Emani S, Sleeper LA, Faraoni D, et al. Thromboelastography is associated with surrogates for bleeding after pediatric cardiac operations. Ann Thorac Surg, 2018, 106(3): 799-806.
9.	Russell L, Haase N, Perner A. Prediction of bleeding by thromboelastography in ICU patients with haematological malignancy and severe sepsis. Blood Coagul Fibrinolysis, 2018, 29(8): 683-688.
10.	Rymuza B, Zbroński K, Scis?o P, et al. Thromboelastography for predicting bleeding in patients with aortic stenosis treated with transcatheter aortic valve implantation. Kardiol Pol, 2018, 76(2): 418-425.
11.	Tuovila M, Erkinaro T, Koivukangas V, et al. Thromboelastography values remain hypercoagulative 6 months after obesity surgery: a pilot study. Obes Surg, 2018, 28(12): 3943-3949.
12.	Barratclough A, Floyd RF, Reep RL, et al. Thromboelastography in wild Florida manatees (Trichechus manatus latirostris). Vet Clin Pathol, 2018, 47(2): 227-232.
13.	Howley IW, Haut ER, Jacobs L, et al. Is thromboelastography (TEG)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open, 2018, 3(1): e000140.
14.	Lee IO, Kim YS, Chang HW, et al. In vitro investigation of the effects of exogenous sugammadex on coagulation in orthopedic surgical patients. BMC Anesthesiol, 2018, 18(1): 56.
15.	Baker JE, Goodman MD, Makley AT, et al. Evaluation of a novel fibrin sealant patch in hemorrhage control after vascular or hepatic injury. Mil Med, 2019, 184(3-4): e290-e296.

1. Shore-Lesserson L, Manspeizer HE, DePerio M, et al. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg, 1999, 88(2): 312-319.
2. 李金澤, 董一君, 錢永軍, 等. 心臟機械瓣膜置換術后抗凝治療遠程管理: 前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2019, 26(4): 343-347.
3. Preisman S, Kogan A, Itzkovsky K, et al. Modified thromboelastography evaluation of platelet dysfunction in patients undergoing coronary artery surgery. Eur J Cardiothorac Surg, 2010, 37(6): 1367-1374.
4. Weitzel NS, Weitzel LB, Epperson LE, et al. Platelet mapping as part of modified thromboelastography (TEG?) in patients undergoing cardiac surgery and cardiopulmonary bypass. Anaesthesia, 2012, 67(10): 1158-1165.
5. Welsh KJ, Padilla A, Dasgupta A, et al. Thromboelastography is a suboptimal test for determination of the underlying cause of bleeding associated with cardiopulmonary bypass and may not predict a hypercoagulable state. Am J Clin Pathol, 2014, 142(4): 492-497.
6. Song JG, Jeong SM, Jun IG, et al. Five-minute parameter of thromboelastometry is sufficient to detect thrombocytopenia and hypofibrinogenaemia in patients undergoing liver transplantation. Br J Anaesth, 2014, 112(2): 290-297.
7. Sharma S, Kumar S, Tewari P, et al. Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery. Ann Card Anaesth, 2018, 21(2): 151-157.
8. Emani S, Sleeper LA, Faraoni D, et al. Thromboelastography is associated with surrogates for bleeding after pediatric cardiac operations. Ann Thorac Surg, 2018, 106(3): 799-806.
9. Russell L, Haase N, Perner A. Prediction of bleeding by thromboelastography in ICU patients with haematological malignancy and severe sepsis. Blood Coagul Fibrinolysis, 2018, 29(8): 683-688.
10. Rymuza B, Zbroński K, Scis?o P, et al. Thromboelastography for predicting bleeding in patients with aortic stenosis treated with transcatheter aortic valve implantation. Kardiol Pol, 2018, 76(2): 418-425.
11. Tuovila M, Erkinaro T, Koivukangas V, et al. Thromboelastography values remain hypercoagulative 6 months after obesity surgery: a pilot study. Obes Surg, 2018, 28(12): 3943-3949.
12. Barratclough A, Floyd RF, Reep RL, et al. Thromboelastography in wild Florida manatees (Trichechus manatus latirostris). Vet Clin Pathol, 2018, 47(2): 227-232.
13. Howley IW, Haut ER, Jacobs L, et al. Is thromboelastography (TEG)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open, 2018, 3(1): e000140.
14. Lee IO, Kim YS, Chang HW, et al. In vitro investigation of the effects of exogenous sugammadex on coagulation in orthopedic surgical patients. BMC Anesthesiol, 2018, 18(1): 56.
15. Baker JE, Goodman MD, Makley AT, et al. Evaluation of a novel fibrin sealant patch in hemorrhage control after vascular or hepatic injury. Mil Med, 2019, 184(3-4): e290-e296.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of thrombelastogram on venous thromboembolism in elderly patients undergoing cardiac surgery

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