Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes
BACKGROUND AND OBJECTIVE: We compared the overall clinical outcome in formula-based protocol (1:1:1) and thromboelastogram (TEG)-guided goal-based massive transfusion (MT) in the resuscitation of patients with hemorrhagic shock. MATERIALS AND METHODS: This was a retro-prospective case–control study...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-01-01
|
| Series: | Asian Journal of Transfusion Science |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/ajts.ajts_56_23 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832593735543685120 |
|---|---|
| author | P. A. Prethika Ganesh Mohan Shamee Shastry Jayaraj Mymbilly Balakrishnan |
| author_facet | P. A. Prethika Ganesh Mohan Shamee Shastry Jayaraj Mymbilly Balakrishnan |
| author_sort | P. A. Prethika |
| collection | DOAJ |
| description | BACKGROUND AND OBJECTIVE:
We compared the overall clinical outcome in formula-based protocol (1:1:1) and thromboelastogram (TEG)-guided goal-based massive transfusion (MT) in the resuscitation of patients with hemorrhagic shock.
MATERIALS AND METHODS:
This was a retro-prospective case–control study conducted over a period of 2 years among the patients who received MT using a 1:1:1 fixed ratio protocol (controls, Group A) and goal-based protocol (cases, Group B) guided through TEG. Patients were matched for the type and severity of the clinical conditions. Utilization of blood components, clinical outcomes, transfusion-related complications, and total mortality rates were compared between the groups.
RESULTS:
There were 113 patients in the formula-based group and 109 patients in the goal-based transfusion group who were matched for injury severity scores. The total blood components utilized were 1867 and 1560, respectively, with a 17.7% reduction associated with the use of TEG. Patients were divided into normal, hypo, and hypercoagulable based on TEG, and a higher transfusion rate was associated with hypocoagulable TEG (942 vs. 610). The prothrombin time, activated partial thromboplastin time, R time, and K time had a significant positive correlation with the need to transfuse more than 20 blood components, whereas platelet count, base excess, alpha angle, MA, and CI had a negative correlation (r = 0.268, P < 0.001). At the end of goal-directed transfusion, 75% of the patients were free of transfusion support (vs. 65.4%) and only 6.9% of the patients had coagulopathy (vs. 31.8%) compared to formula-based resuscitation with a 10% reduction in mortality.
CONCLUSION:
TEG-guided goal-based approach helped to reduce blood component utilization with a reduced incidence of coagulopathy at the end of the MT while improving patient survival. |
| format | Article |
| id | doaj-art-9440505e8a91457cb3e1536a0dec9885 |
| institution | Kabale University |
| issn | 0973-6247 1998-3565 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Asian Journal of Transfusion Science |
| spelling | doaj-art-9440505e8a91457cb3e1536a0dec98852025-01-20T09:21:49ZengWolters Kluwer Medknow PublicationsAsian Journal of Transfusion Science0973-62471998-35652024-01-0118171510.4103/ajts.ajts_56_23Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomesP. A. PrethikaGanesh MohanShamee ShastryJayaraj Mymbilly BalakrishnanBACKGROUND AND OBJECTIVE: We compared the overall clinical outcome in formula-based protocol (1:1:1) and thromboelastogram (TEG)-guided goal-based massive transfusion (MT) in the resuscitation of patients with hemorrhagic shock. MATERIALS AND METHODS: This was a retro-prospective case–control study conducted over a period of 2 years among the patients who received MT using a 1:1:1 fixed ratio protocol (controls, Group A) and goal-based protocol (cases, Group B) guided through TEG. Patients were matched for the type and severity of the clinical conditions. Utilization of blood components, clinical outcomes, transfusion-related complications, and total mortality rates were compared between the groups. RESULTS: There were 113 patients in the formula-based group and 109 patients in the goal-based transfusion group who were matched for injury severity scores. The total blood components utilized were 1867 and 1560, respectively, with a 17.7% reduction associated with the use of TEG. Patients were divided into normal, hypo, and hypercoagulable based on TEG, and a higher transfusion rate was associated with hypocoagulable TEG (942 vs. 610). The prothrombin time, activated partial thromboplastin time, R time, and K time had a significant positive correlation with the need to transfuse more than 20 blood components, whereas platelet count, base excess, alpha angle, MA, and CI had a negative correlation (r = 0.268, P < 0.001). At the end of goal-directed transfusion, 75% of the patients were free of transfusion support (vs. 65.4%) and only 6.9% of the patients had coagulopathy (vs. 31.8%) compared to formula-based resuscitation with a 10% reduction in mortality. CONCLUSION: TEG-guided goal-based approach helped to reduce blood component utilization with a reduced incidence of coagulopathy at the end of the MT while improving patient survival.https://journals.lww.com/10.4103/ajts.ajts_56_23blood utilizationgoal-directed massive transfusionhemorrhagic shockmassive transfusionthromboelastogram |
| spellingShingle | P. A. Prethika Ganesh Mohan Shamee Shastry Jayaraj Mymbilly Balakrishnan Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes Asian Journal of Transfusion Science blood utilization goal-directed massive transfusion hemorrhagic shock massive transfusion thromboelastogram |
| title | Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes |
| title_full | Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes |
| title_fullStr | Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes |
| title_full_unstemmed | Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes |
| title_short | Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes |
| title_sort | tailoring transfusion strategy using thromboelastogram in goal directed massive transfusion impact on transfusion requirements and clinical outcomes |
| topic | blood utilization goal-directed massive transfusion hemorrhagic shock massive transfusion thromboelastogram |
| url | https://journals.lww.com/10.4103/ajts.ajts_56_23 |
| work_keys_str_mv | AT paprethika tailoringtransfusionstrategyusingthromboelastogramingoaldirectedmassivetransfusionimpactontransfusionrequirementsandclinicaloutcomes AT ganeshmohan tailoringtransfusionstrategyusingthromboelastogramingoaldirectedmassivetransfusionimpactontransfusionrequirementsandclinicaloutcomes AT shameeshastry tailoringtransfusionstrategyusingthromboelastogramingoaldirectedmassivetransfusionimpactontransfusionrequirementsandclinicaloutcomes AT jayarajmymbillybalakrishnan tailoringtransfusionstrategyusingthromboelastogramingoaldirectedmassivetransfusionimpactontransfusionrequirementsandclinicaloutcomes |