The Clinical Application Of Heparinase-modified Thromboelastography Before Coronary Artery Bypass Grafting

Objective:To explore the clinical values of heparinase-modified thromboelastography(hmTEG) before the operation of coronary artery bypass grafting (CABG)Methods:According to the inclusion criteria of experimental design,67 patients with normal conventional blood coagulation profiles measured on admission were enrolled. All cases were tested by hmTEG before off-pump CABG and divided into three groups according to the results of the coagulation index(CI) value:Group A(35 cases in hypocoagulabal group),Group B(30 cases in normal group),and Group C(2 cases in hypercoagulabal group). The possible reasons of differential outcome were analysed, and the clinical data and hmTEG values were compared statistically between Group A and Group B.Results:(1)Two patients required rethoracotomy for excessive tube drainage 24 hours postoperatively.Surgical exploration showed:one case in Group A was due to blood oozing from the wound surface, another in Group B was because of anastomic bleeding of vascular bridge.(2)The parameters of R time,k time were longer, and α-Angle, MA values were lower in Group A than those in Group B(P<0.001).(3)The patients in Group A had more intraoperative blood loss, more postoperative tube drainage, higher ratio of patients with total drainage> 1000ml, longer tube removed time and more blood product transfusions than those of Group B(P<0.05).Conclusions:(1)hmTEG assay is comprehensive and accurate to evaluate the basal blood coagulation status of patients before the surgery of CABG.(2)Hypocoagulation indicated by hmTEG is one of risk factors leading to increased intraoperative bleeding, postoperative tube drainage and blood products transfusions. (3) hmTEG assay is important clinically in assessment of perioperative coagulation function and guiding treatment in patients undergoing CABG.