| The incremental value of thrombelastography for prediction of excessive blood loss after cardiac surgery: an observational study. | |
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MedLine Citation:
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PMID: 20610554 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Accurate risk stratification may help reduce the burden of excessive blood loss after cardiac surgery. We measured the incremental value of thrombelastography to an existing risk prediction model for excessive blood loss in cardiac surgery. METHODS: This observational study included 434 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) and had thrombelastographic measures before and during CPB, their risk of excessive blood loss could be calculated with an existing risk prediction model and they had not received clopidogrel or warfarin within 5 days of surgery. Excessive blood loss was defined as transfusion of > or = 5 U of red blood cells from termination of CPB to 1 day after surgery. Logistic regression models including an existing risk prediction model without and with thrombelastographic measures were constructed. Improvement in risk prediction was measured by the area under the curve and net reclassification improvement. RESULTS: Excessive blood loss occurred in 59 of 434 patients (13.6%). The only thrombelastographic measure that improved risk stratification was maximum amplitude during CPB, which reflects maximum clot strength. Although the addition of this variable to the existing prediction model did not have a material effect on the area under the curve (increased from 0.780 to 0.784; P = 0.8), it did improve the net reclassification improvement by 12% (P = 0.05), primarily by improving the detection of high-risk cases. CONCLUSIONS: Risk stratification for excessive blood loss after cardiac surgery is improved when on-CPB thrombelastography is added to an existing risk prediction model that incorporates readily available patient- and surgery-related variables, but large, multicenter trials are needed to verify this finding and create a new risk prediction model. |
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Authors:
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Marcin Wasowicz; Stuart A McCluskey; Duminda N Wijeysundera; Terrence M Yau; Massimiliano Meinri; W Scott Beattie; Keyvan Karkouti |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-07-07 |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 111 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-28 Completed Date: 2010-08-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 331-8 Citation Subset: AIM; IM |
Affiliation:
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Toronto General Hospital, 200 Elizabeth St., 3EN-402 Toronto, ON, Canada M5G 2C4. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Blood Coagulation* Cardiac Surgical Procedures / adverse effects* Cardiopulmonary Bypass / adverse effects Chi-Square Distribution Erythrocyte Transfusion Female Humans Logistic Models Male Middle Aged Odds Ratio Ontario Postoperative Hemorrhage / blood, diagnosis*, etiology, therapy Predictive Value of Tests Retrospective Studies Risk Assessment Risk Factors Sensitivity and Specificity Thrombelastography* Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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//Canadian Institutes of Health Research |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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