THROMBOELASTROMETRY AS A GUIDE FOR BLOOD MANAGEMENT IN THORACOABDOMINAL ANEURYSM SURGERY

AUTHORS: Bueno L., Martins K., Beltrao R., Fossati S., Cernuda I., Aguilar C.

Background and Goal of the Study
	Thromboelastometry (ROTEM®) is a viscoelastometric method that tests coagulation in a fast and dynamic way analysing a whole blood sample. The aim of this study was to assess the results of using thromboelastometry as guidance for haemoderivates management in thoracoabdominal aneurysms open repair.
	The classic transfusion protocols recommend the administration of fresh frozen plasma (PFC) in situations of significant intraoperative bleeding. This non-selective administration has been associated with an increase of postoperative complications, especially pulmonary.

Material and methods
A prospective cohort study was performed with nonrandomized sampling using a retrospective control group. 29 patients undergoing thoracoabdominal aneurysms open repair were included. In 14 patients blood products were transfused according to classic protocols (Group A), while in the remaining 15, thromboelastometric based transfusion algorithms were used (Group B).
	Our main variables were fresh frozen plasma administration, fibrinogen supply and platelet transfusion. Secondary variables were: postoperative adverse events, ICU and hospital stay.

Results and discussion
	We analyzed 29 patients (14 group A and 15 group B), with an homogeneous distribution between both groups. 
For data analysis, Student's T and Man Whitney U tests were used for the quantitative variables. However, for main variables analysis we categorized the data and applied the Chi square test.
	There was a decreamental transfusion of fresh frozen plasma in group B respect group A (p = 0.017), with 13.4% and 78.5% patients transfused respectively. Fibrinogen was administered in 86.7% of patients in group B, respect 35.7% of patients in group A (p=0.009). There was a rise in the use of platelets in group A 92.8%, respect group B 73.3% (p=0.038). 
	Also 35.7% of patients in group A had postoperative respiratory complications, respect group B with 6.7%, although these differences were not statistically significant (p=0.08).
	No differences were found in prothrombin complex administration, homologous blood transfusion, UCI or hospital stay.

Conclusions
Based on our experience, the use of a viscoelastic tests such as thromboelastometry, allows a substantial change in the management of blood products, with a decrease in the use of fresh frozen plasma and increase in the administration of fibrinogen. Regarding postoperative respiratory complications it seems that increasing our sample could yield to statistically significant results.




04 / Thromboelastrometry as a guide for blood management in thoracoabdominal aneurysm surgery