Near-patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Andrew D Mumford, Jessica Harris, Zoe Plummer, Kurtis Lee, Veerle Verheyden, Barnaby C Reeves, Chris A Rogers, Gianni D Angelini, Gavin J Murphy

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Abstract

Background: Coagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near-patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre-emptive near-patient testing to predict whether severe bleeding will occur.

Objectives: To evaluate how well a comprehensive panel of 28 near-patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.

Methods: Single-center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re-operation for bleeding or administration of a pro-haemostatic treatment directed by clinician judgement.

Results: In 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near-patient test results was 5/28 per patient (range 0-18). CCB occurred in 449/1833 patients (24.5%). The c-statistic for a predictive model for CCB using only baseline clinical characteristics (baseline-only model) was 0.72 (95% CI 0.69-0.75). Addition of near-patient test results to this model (baseline-plus-test model) improved the prediction of CCB (c-statistic 0.75 [0.72-0.77]), but increased the number of correctly classified patients by only 18 (0.98%).

Conclusions: Near-patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

Original languageEnglish
Pages (from-to)242-251
Number of pages10
JournalResearch and Practice in Thrombosis and Haemostasis
Volume1
Issue number2
Early online date25 Jul 2017
DOIs
Publication statusPublished - Oct 2017

Structured keywords

  • Centre for Surgical Research
  • BTC (Bristol Trials Centre)

Keywords

  • blood coagulation
  • blood component transfusion
  • cardiac surgery
  • hemorrhage
  • point-of-care systems

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