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Minimally invasive transfusion: Rotational thromboelastometry (ROTEM®) based coagulation management in cardiovascular surgery.
Masahito Minakawa, Takashi Ogasawara, Ikuo Fukuda, Yasuyuki Suzuki.
Hirosaki University Graduate School of Medicine, Hirosaki, Japan.

OBJECTIVE:
Rotational thromboelastometry (ROTEM ®) has been developed in Germany and has been used in the world. In Japan it has become a clinical use. But unfortunately usefulness of ROTEM ® is not well known. We investigated the effect of ROTEM ® based coagulation management in
cardiopulmonary bypass surgery.
METHODS: A retrospective review was performed of 199 patients undergoing cardiopulmonary bypass surgery between January 2011 and October 2012. In a ROTEM group (group R, n = 82) patients treated with allogeneic blood products (fresh frozen plasma, followed by platelet concentrates) according to intraoperative ROTEM ® tests (FIBTEM A10 is aimed at the value of at least 10mm; normal range 7-23mm) and complete blood counts. In control group (group C, n = 117) patients was treated with allogeneic blood products (platelet concentrates, followed by fresh frozen plasma) according to activated coagulation time (ACT) and complete blood counts. Preoperative variables, intraoperative variables, perioperative blood loss, and amount of blood products were analyzed.
RESULTS: Preoperative and intraoperative variables were similar between groups without rate of female patients (30.1% in group R vs 50.4% in group C; P =0.016). There were significant differences about intraoperative blood loss between groups(1159 mL
in group R vs 1686 mL in group C; P = 0.014). Intraoperative transfusion of fresh-frozen plasma was not reduced in the group R (1097 mL in group R vs 1241 mL in group C; P = 0.930). But the use of platelet concentrate and red blood cells were significantly decreased in the group R (RBC: 488 mL in group R vs 713 mL in group C; P <0.05. PC:148 mL in group R vs 311 mL in group C; P <0.05).
CONCLUSIONS: By ROTEM® we can frequently measured fibrinogen plasma levels and reduced unnecessary transfusions of platelet concentrate without increasing the perioperative bleeding.

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