Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery

• Autor(a) principal: Andre Soares Santos
• Data de Publicação: 2019
• Outros Autores: Kenya Valeria Micaela de Souza Noronha, Monica Viegas Andrade
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://hdl.handle.net/1843/59072
• topic: Bleeding; Coagulopathy; Point of care testing; Transfusion; Viscoelastic blood testconcentration; Cirurgia cardiaca; Coagulacao; Transfusão de componentes sanguineos

The meta-analysis by Serraino and Murphy1 on viscoelastic haemostatic assays (VHA) for the diagnosis and treatment of coagulopathic bleeding in cardiac surgery and subsequent comments2,3 suggest some uncertainty around the association between transfusion of allogeneic red blood cells, fresh frozen plasma, and platelets and final outcomes, as discussed.1 Kozek and colleagues2 made two arguments using final outcomes to justify their support of VHA: (i) the observed risk reduction in acute renal failure reported by Serraino and Murphy1 (odds ratio [OR]=0.42, 95% confidence interval [CI]=0.20–0.86; P=0.02; four studies, 424 patients; data taken from supplementary materials provided by the authors) and (ii) the risk reduction in mortality reported by Wikkelsø and colleagues4,5 (3.9% vs 7.4%; relative risk [RR]=0.52, 95% CI=0.28–0.95; P=0.033, not specific for cardiac patients). We agree that the reduction of the risk of acute renal failure is an important outcome, but the mortality reduction reported by Wikkelsø and colleagues4,5 was found through a fixed-effects model combining data from different populations. Heterogeneity was null, but a random-effects model (REM) would be advised regardless.