The Predictive Value Of Preoperative Thromboelastography For Postoperative Excessive Bleeding In Patients With Acute Aortic Dissection

Objective:The purpose of this study was to evaluate the ability of thromboelastography(TEG)to predict postoperative excessive bleeding in patients with acute aortic dissection(AAD)undergoing thoracic aortic procedures involving deep hypothermic circulatory arrest(DHCA).Methods:We retrospectively investigated patients with AAD treated in our hospital from 2014-01 to 2015-12,who had done TEG test before the surgery.According to the chest tube drainage(CTD)within 24 hours after the surgery,patients were divided into 2 groups:the excessive bleeding group and the control group.Excessive bleeding was defined as the CTD?1000ml within 24 hours after surgery.The patient demographic information,laboratory examination,imaging examination,TEG parameters within 3 days before the surgery,procedure characteristics,anesthesia characteristics,dose of CTD after the surgery and total allogeneic blood usage were collected retrospectively and analyzed.Results:A total of 104 patients were enrolled in this study.Among them,21 patients(20.2%)had excessive bleeding.Compared with the control group,preoperative PLT[156(118.5,191)vs 185(155,229),P=0.019]and MA(54.9±8.7 vs 61.5±7.7,P=0.01)were significantly decreased in the bleeding group.In multivariate logistic regression analysis,preoperative MA(OR=0.895,95%Cl:0.834-0.960)was the independent predictor of postoperative excessive bleeding.The predictive accuracy is enhanced(area under the receiver operator curve is 0.732)and the negative predictive value for the MA is 84.3%,although the positive predictive value is poor(57.1%).Conclusion:The preoperative MA parameter from TEG can predict postoperative excessive bleeding in patients with acute aortic dissection,which can give some guidance to the clinical therapy.