Table 2 Studies evaluating the effect of TEG vs. routine coagulation tests (RCoT) on haemostasis in surgical patients
From: Thrombelastography and tromboelastometry in assessing coagulopathy in trauma
Author | Patients | No. | Study type | Major conclusions |
|---|---|---|---|---|
Kang (1985) | Liver surgery | 66 | RC | VHA based therapy reduced blood and fluid infusion volume by 33% vs. RCoT therapy |
McNicol (1994) | Liver surgery | 75 | RC | VHA enabled specific and selective use of FFP, PLT and cryoprecipitate |
Kang (1995) | Liver surgery | 80 | RC | VHA identified clinically relevant fibrinolysis and enabled specific pharmacological therapy |
Harding (1997) | Liver surgery | 55 | RC | VHA-heparinase enabled identification of coagulopathy present under the heparinisation |
Chau (1998) | Liver surgery | 20 | PO | VHA predicted re-bleeding in cirrhotic patients with variceal bleeding, whereas RCoT did not |
Tuman (1987) | Cardiac surgery | 87 | RC | VHA allowed rapid intraoperative diagnosis of coagulopathy during CPB |
Spiess (1987) | Cardiac surgery | 38 | RC | VHA was a better predictor (87% accuracy) of postoperative haemorrhage and need for reoperation than RCoT (30-51% acuracy) |
Tuman (1989) | Cardiac surgery | 42 | RC | VHA, but not RCoT, predicted postoperative bleeding in patients post-CPB |
Essell (1993) | Cardiac surgery | 36 | PO | VHA had higher specificity in predicting patients likely to benefit from FFP and PLT therapy than RCoT |
Tuman (1994) | Cardiac surgery | 51 | RC | VHA-heparinase revealed post-CPB coagulopathy |
Spiess (1995) | Cardiac surgery | 1,079 | PI vs. RC | VHA guided transfusion therapy significantly reduced overall incidence of transfusion and total transfusions in the OR as compared to RCoT |
Shih (1997) | Cardiac surgery | 43 | RC | VHA demonstrated higher sensitivity and specificity than RCoT for detecting post-CPB bleeding |
Cherng (1998) | Cardiac surgery | 74 | RC | Re-do patients demonstrated reduced pre-operative α-angle and MA/MCF was significantly reduced compared to patients not needing re-exploration |
Shore-Lesserson (1999) | Cardiac surgery | 105 | RCS | VHA treated patients received fewer postoperative FFP and PLT transfusions than patients treated based on PCoT |
Royston (2001) | Cardiac surgery | 90 | IS | VHA guided transfusion therapy reduced the need for FFP and PLT threefold vs. RCoT |
Manikappa (2001) | Cardiac surgery | 150 | RCS | VHA had higher accuracy than RCoT to predict patients developing excessive postoperative bleeding and significantly reduced the need for RBC, FFP and PLT transfusions |
Welsby (2006) | Cardiac surgery | 30 | PO | VHA MA/MCF showed better correlation with postoperative bleeding than RCoT |
Anderson (2006)* | Cardiac surgery | 990 | PI vs. RC | VHA guided therapy reduced the need for RBC, FFP and PLT as compared to RCoT directed therapy |
Westbrook (2008) | Cardiac surgery | 69 | RC | VHA-based management reduced total product usage by 58.8% in the study group vs. RCoT group |
Reinhöfer (2008)* | Cardiac surgery | 150 | RC | Clot strength, but not RCoT, had the highest predictive value for excess postoperative blood loss |
Johansson (2009) | Massive transfusion | 832 | PI vs. RC | VHA guided therapy reduced mortality from 31% to 20% in massively bleeding patients |