Prediction of Postoperative Blood Loss Using Thromboelastometry in Adult Cardiac Surgery: Cohort Study and Systematic Review
Objective
The aim was to evaluate the predictive value of thromboelastometry for postoperative blood loss in adult cardiac surgery with cardiopulmonary bypass.
Design
Retrospective cohort study and systematic review of the literature.
Setting
A tertiary university hospital.
Participants
202 patients undergoing elective cardiac surgery.
Interventions
Thromboelastometry was performed before cardiopulmonary bypass and 3 minutes after protamine administration.
Measurements and Main Results
The cohort study showed that the preoperative and postoperative thromboelastometric positive predicting value was poor (0%-22%); however, the negative predicting value was high (89%-94%). The systematic review of the literature to evaluate the predictive value of thromboelastometry for major postoperative bleeding in cardiac surgery resulted in 1,311 articles, 11 of which were eligible (n = 1,765; PubMed and Embase, until June 2016). Two studies found a good predictive value, whereas the other 9 studies showed a poor predictability for major postoperative bleeding after cardiac surgery. The overall negative predicting value was high.
Conclusions
Thromboelastometry does not predict which patients are at risk for major postoperative bleeding.