Point of Care Management of Perioperative Coagulopathy Reduces Blood Loss and Consumption of Blood Transfusion Products (Preliminary Results)

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; p. S326
• Main Authors: Durila, M., Vajter, J., Lischke, R., Berousek, J., Vymazal, T.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.822

Lung transplantation is very often accompanied with significant bleeding and coagulopathy. Standard perioperative management consists of administering fresh frozen plasma (FFP) and red blood cells. These transfusion products are generally administered according to anesthesiologist's decision based on his personal experience. However, point of care (POC) monitoring of coagulopathy is available nowadays such as thrombolestometry (ROTEM), platelet function analyzer (PFA 200) and agregometry (Multiplate) to conduct administering of blood products or coagulation factors. The purpose of this study is to find out if POC management of bleeding and coagulopathy can reduce perioperative blood loss and consumption of blood products compared to standard approach. Eighteen patients undergoing bilateral lung transplantation were randomized into 2 groups (from January 2018). In the first group (9 patients), management of bleeding and coagulopathy was done by anesthesiologist based on his clinical experience - standard approach, in the second group (9 patients), management of bleeding and coagulopathy was based on results of POC methods such as ROTEM, PFA 200, Multiplate. In POC group we found significantly reduced consumption of FFP and red blood cells during surgery and 24 hours after surgery. Also, perioperative blood loss was decreased in POC group comparing to standard approach group. Results are summarized in Table. Management of bleeding and coagulopathy based on results of POC methods such as ROTEM, PFA 200 and Multiplate significantly reduces consumption of blood products and decreases perioperative blood loss, despite a small number of patients.