Introduction: Neurotrauma and Neurocritical care (NCC) patients have significant risk of morbidity and mortality from intracranial hemorrhage. Rapid identification of patients with coagulopathy followed by prompt reversal may lead to improved patient outcomes. The goal of our study was to evaluate the effect of our institutional thromboelastography (TEG) algorithm on estimated blood loss (EBL) in patients undergoing surgery, length of stay (LOS), in-hospital complications, and mortality.
Methods: A total of 100 consecutive patients admitted to our NCC unit were retrospectively evaluated. Patient demographics, admission TEG data, admission laboratory studies, TEG guided reversal of anticoagulation, perioperative data, length of hospital stay, disposition, and in-hospital complications were gathered from the electronic medical record. Multivariate linear regression and logistic regression analysis was performed for estimated blood loss in patients undergoing surgery, length of hospital stay, in-hospital complications, and mortality controlling for clinically important variables.
Results: TEG guided transfusions and reversal of anticoagulation did not have a significant effect on blood loss following first major surgery during hospitalization or length of hospital stay. Older patients and those undergoing operative procedures during hospitalization had a significantly longer hospital stay. Patients who underwent TEG guided transfusions were found to have significantly fewer thrombotic complications. TEG guided medical reversal of anticoagulation was significantly associated with fewer rebleeding complications. Higher admission GCS score and TEG guided medical reversal of anticoagulation were significantly associated with lower mortality rates.
Conclusions: TEG guided transfusions and medical reversal were found to significantly decrease thrombotic complications and mortality respectively. The use of our institutional TEG-guided transfusion algorithm appears to have no effect on overall patient blood loss during surgery or length of hospital stay. Future prospective studies are needed to validate this initial analysis.
Patient Care: This research will improve patient care by showing the utility of thromboelastography in the acute neurocritical care setting. This study suggests that thromboelastography is an accurate and effective way to reverse unwanted anticoagulation. In addition to being safe, it also decreases thrombotic complications - DVT, PE, MI, CVA - and mortality.
Learning Objectives: To provide education on the value of thromboelastography for routine use in Neurosurgical practice. This study, although retrospective, shows that thromboelastography can help guide rapid reversal of unwanted anticoagulation while decreasing thrombotic complications and mortality.