Following the Guideline for Using the Whole Blood Viscoelastic Test - Three Old but New Challenges in Cardiovascular Anesthesia -

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  • KIKURA Mutsuhito
    Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organization of Occupational Health and Safety

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  • 血液粘弾性試験の使用指針を受けて─心臓血管麻酔の古くて新しい3つの課題─

Abstract

<p>The whole blood viscoelastic device has brought dramatic progression in coagulation management in cardiothoracic vascular anesthesia. At the same time, the device has provided new answers to old and unsolved problems including 1）the etiology of heparin resistance; 2）proper dosage of protamine for heparin reversal; and 3）advantages of point-of-care monitoring with a viscoelastic device in patient blood management. On those three tough questions in cardiothoracic vascular anesthesia, this review provides new practical information for physicians by analyzing and discussing the clinical data. First, thromboelastometry elucidates that the main etiology of heparin resistance is increased coagulation system including fibrinogen level and platelet counts rather than a decrease in antithrombin activity. Second, thromboelastometry elucidates that a proper protamine dosage for heparin neutralization is 0.73-fold of total heparin amounts. Third, previous reports and our clinical study with viscoelastic devices indicate that the main benefit of point-of-care monitoring with a viscoelastic device is a reduction in unnecessary blood transfusion in cardiothoracic vascular anesthesia. Fibrinogen replacement therapy with cryoprecipitate or fibrinogen concentrate may overcome the limitations of the viscoelastic device, and further clinical studies of fibrinogen replacement therapy are warranted in cardiothoracic vascular anesthesia in the future.</p>

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