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Authors
Advisor(s)
Abstract(s)
A cirurgia cardíaca está frequentemente associada a risco hemorrágico elevado peroperatório
e pós-operatório, especialmente em cirurgias com circulação extracorporal (CEC).
As alterações da coagulação consequentes têm uma etiologia multifatorial. Uma melhor
vigilância do estado hemostático destes doentes tem um impacto significativo, uma vez que o
tratamento e suporte transfusional podem ser direcionados. No entanto sabe-se que os testes
clássicos da coagulação têm limitações. A tromboelastometria é um teste que permite efetuar
uma observação global da hemostase, sendo por isso, uma ferramenta útil para avaliar a
hemorragia, a presença de coagulopatia e os efeitos da administração de componentes e
derivados sanguíneos. Atualmente é utilizada em diversas áreas, nomeadamente na cirurgia
cardíaca, vascular e hepática.
Este estudo teve como objetivo comparar a utilização do ROTEM com os testes
clássicos da coagulação, na avaliação e monitorização das alterações na hemostase, em
doentes submetidos a cirurgia cardíaca. Pretendeu-se verificar se a tromboelastometria permite
prever o risco hemorrágico e orientar uma terapêutica mais específica.
Foram estudados 16 doentes submetidos a cirurgia cardíaca complexa (substituições
de próteses valvulares, valvuloplastias e bypasses coronários) entre Outubro de 2012 e Abril
de 2013. A avaliação laboratorial foi feita por testes clássicos da coagulação e, em paralelo, por
tromboelastometria. A avaliação clínica foi baseada no registo da administração de
componentes sanguíneos e/ou derivados durante e após a cirurgia (primeiras 24 horas).
Comparamos os resultados dos testes da hemostase, ao longo das intervenções
cirúrgicas e encontramos diferenças estatisticamente significativas, tanto pelos métodos
convencionais, como pelos do ROTEM.
Contudo, depois de avaliados todos os parâmetros, este trabalho parece não
demonstrar que o ROTEM seja mais eficiente que os testes clássicos da coagulação para nos
orientar na administração dos componentes ou derivados sanguíneos e prever o risco de
hemorragia. No entanto, o número de casos estudado é reduzidos, o que impossibilita concluir
de forma sustentada sobre o real valor deste teste na rotina assistencial. Terão que ser feitos
mais estudos, a um maior número de doentes, acompanhados de uma estandardização de
protocolos, pessoal treinado na execução e interpretação do teste de forma que a utilização da
tromboelastometria possa vir a tornar-se num teste alternativo a implementar em casos de
coagulopatias.
Cardiac surgery is frequently associated with intraoperative and postoperative high bleeding risk, especially in surgeries that involve extracorporeal circulation. The consequent coagulation abnormalities have a multifactorial aetiology. An improved monitoring of these patients’ haemostatic condition has a significant impact because it can guide treatment and transfusional support. However, it is known that the classical coagulation tests are limited. Thromboelastometry is a test that allows us to globally observe haemostasis, being a useful tool to assess the bleeding, the presence of a coagulopathy and the effects of the administration of blood components and derivatives. It is currently used in various fields, such as cardiac, vascular and liver surgery. The present study aimed to compare the ROTEM and the classic coagulation tests relating to the evaluation and monitoring of the changes in haemostasis in patients who underwent cardiac surgery. Its goal is to verify if thromboelastometry can predict the bleeding risk and guide a more specific therapy. 16 patients who underwent complex cardiac surgery (replacements of prosthetic valves, valvuloplasties and coronary bypasses) were studied between October 2012 and April 2013. The laboratory evaluation was carried out using classical coagulation tests and thromboelastometry. The clinical evaluation was based on the registration of the blood components and/or derivatives administered both during and in the 24 hours that followed surgery. We compared the results of the haemostasis tests throughout the surgical interventions and found statistically significant differences, both by conventional methods and by ROTEM However, after evaluating all parameters this study doesn’t seem to reveal the ROTEM to be more efficient than the classical coagulation tests to guide us in the administration of blood components and derivatives and predict the risk of bleeding, despite the fact that the number of cases studied is low, making it impossible to conclude steadily over the real value of this test in routine care. Further studies will have to be conducted, with a larger number of patients, a standardization of protocols and personnel trained to perform and interpret the test, so that thromboelastometry can become an alternative test to implement in cases of coagulopathy.
Cardiac surgery is frequently associated with intraoperative and postoperative high bleeding risk, especially in surgeries that involve extracorporeal circulation. The consequent coagulation abnormalities have a multifactorial aetiology. An improved monitoring of these patients’ haemostatic condition has a significant impact because it can guide treatment and transfusional support. However, it is known that the classical coagulation tests are limited. Thromboelastometry is a test that allows us to globally observe haemostasis, being a useful tool to assess the bleeding, the presence of a coagulopathy and the effects of the administration of blood components and derivatives. It is currently used in various fields, such as cardiac, vascular and liver surgery. The present study aimed to compare the ROTEM and the classic coagulation tests relating to the evaluation and monitoring of the changes in haemostasis in patients who underwent cardiac surgery. Its goal is to verify if thromboelastometry can predict the bleeding risk and guide a more specific therapy. 16 patients who underwent complex cardiac surgery (replacements of prosthetic valves, valvuloplasties and coronary bypasses) were studied between October 2012 and April 2013. The laboratory evaluation was carried out using classical coagulation tests and thromboelastometry. The clinical evaluation was based on the registration of the blood components and/or derivatives administered both during and in the 24 hours that followed surgery. We compared the results of the haemostasis tests throughout the surgical interventions and found statistically significant differences, both by conventional methods and by ROTEM However, after evaluating all parameters this study doesn’t seem to reveal the ROTEM to be more efficient than the classical coagulation tests to guide us in the administration of blood components and derivatives and predict the risk of bleeding, despite the fact that the number of cases studied is low, making it impossible to conclude steadily over the real value of this test in routine care. Further studies will have to be conducted, with a larger number of patients, a standardization of protocols and personnel trained to perform and interpret the test, so that thromboelastometry can become an alternative test to implement in cases of coagulopathy.