Can ROTEM thromboelastometry predict postoperative bleeding after cardiac surgery?

OBJECTIVE To evaluate the predictive ability of ROTEM thromboelastometry (Pentapharm, Basel, Switzerland) to identify patients bleeding more than 200 mL/h in the early postoperative period after cardiac surgery. DESIGN A prospective observational study. SETTING A single university hospital. PARTICIPANTS Fifty-eight adult male and female patients undergoing primary coronary artery revascularization. INTERVENTIONS Blood samples taken preoperatively and at 1, 2, and 3 hours after surgery. MEASUREMENTS AND MAIN RESULTS Eight patients bled at least 200 mL/h in the study period. All (100%) had at least 1 abnormal ROTEM result in the study period. Of the 49 patients not found to be bleeding more than 200 mL/h in any of the first 4 postoperative hours, 46 (94%) had at least 1 abnormal ROTEM result. The positive and negative predictive values were 14.8% and 100%, respectively. CONCLUSIONS ROTEM thromboelastometry has poor predictive utility to identify patients who bleed more than 200 mL/h in the early postoperative period after cardiac surgery. However, its negative predictive value was good.

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