Monitoring of coagulation status using thrombelastography during paediatric open heart surgery

P. Martin, F. Horkay, S. M. Rajah, D. R. Walker

Research output: Contribution to journalArticle

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Abstract

Thrombelastography (TEG) has proved useful in identifying coagulopathies (via assessment of clot elasticity properties) during hepatic surgery, but its role in cardiac surgery has as yet not been defined. Twenty-two children [11M, 11F, mean age (range) 4.9 (0.1-16) years] undergoing open heart surgery were investigated [1] preoperatively, [2] 15 min post protamine, [3] 2 h and [4] 24 h postoperatively using TEG. Comparisons were made between pre- and postoperative measurements and haematological indices. The values obtained from the TEG were: R phase (indicative of thrombokinase and thrombin formation disorders), K phase (indicative of fibrinogenesis) and MA phase (providing information on clot stability and platelet function). The patients were divided into two groups based upon 24 h blood loss; Group 1 - blood loss <0.7 ml/kg/h and Group 2 - blood loss > 0.7 ml/kg/h. In Group 2 there was a highly significant correlation between post-protamine MA phase and platelet number (r=0.93, p 0.1). Furthermore, in Group 2 elevated postoperative blood loss was associated with a prolonged K phase (mean [SD] 12.0 [6.0] versus 6.3 [2.1] min, p 0.5 and p > 0.2, respectively). TEG predicted with 100% (8/8) accuracy increased post-operative bleeding. The specificity of TEG prediction of future bleeding was 73% [8/11]. Alterations in TEG parameters merit further evaluation as markers of postoperative haemorrhage.

Original languageEnglish
Pages (from-to)183-187
Number of pages5
JournalInternational Journal of Clinical Monitoring and Computing
Volume8
Issue number3
DOIs
Publication statusPublished - Sep 1991

Fingerprint

Thrombelastography
Thoracic Surgery
Pediatrics
Postoperative Hemorrhage
Hemorrhage
Factor Xa
Protamines
Elasticity
Blood Group Antigens
Platelet Count
Thrombin
Blood Platelets
Liver

Keywords

  • bleeding
  • cardiopulmonary bypass
  • children
  • thrombelastography

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine (miscellaneous)

Cite this

Monitoring of coagulation status using thrombelastography during paediatric open heart surgery. / Martin, P.; Horkay, F.; Rajah, S. M.; Walker, D. R.

In: International Journal of Clinical Monitoring and Computing, Vol. 8, No. 3, 09.1991, p. 183-187.

Research output: Contribution to journalArticle

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