Results/Findings: In the post-protocol implementation patient population, PM™ data was collected either before or during surgery 88% (92/104) of the time. This represents a dramatic increase from our previous study, in which PM™ data was collected either before or during surgery only 58% of the time prior to protocol implementation. Of the 92 patients who received PM™ before or during surgery, 76 patients (83%) were found to be inhibited. However, of that 83%, only 25 patients (33%) received platelet transfusions at any point in time, compared with 40% prior to protocol implementation. Finally, almost a third (11/36) of all patients receiving transfusions had normal platelet function studies at every point in time, despite no documentation of surgical or coagulopathic bleeding. Conclusions: We previously proposed that PM™ was underutilized in the CT surgery setting. The implementation of this protocol has increased adherence to testing in the CT surgery setting, with near-perfect compliance with regards to ordering PM™. However, despite a clear transfusion guideline accompanying this test, it remains to show significant changes in how clinicians decide to transfuse in the operative setting. Further physician education and buy-in may be needed from key players, such as anesthesia personnel, in order to improve patient outcomes.
Importance of research: Thromboelastography point-of-care assays have significant potential to identify high-risk patients in cardiac surgery before they reach the operating room, such that appropriate pre-operative interventions can be provided. Additionally, best practices in patient blood management should minimize unnecessary transfusions in light of pressing blood shortages so that resources can be prioritized in populations with the highest need.
