Σάββατο 9 Σεπτεμβρίου 2017

Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis

Editor—With great interest we read the systematic review and meta-analysis on the routine use of viscoelastic haemostatic assays (VHA) for diagnosis and treatment of coagulopathic bleeding in cardiac surgery published by Serraino and Murphy.1 Significant reductions in red blood cell transfusion requirements by the use of VHA have been confirmed by previous Cochrane reviews.23 Reducing the exposure to allogeneic blood products is a clear perioperative management goal improving patient outcome and recommended by evidence-based bleeding guidelines.4 Moreover, Serraino and Murphy report significant reductions in platelet transfusion and plasma transfusion (RR 0.78, 95% CI 0.66–0.93; P=0.004), which is also clinically highly relevant considering specific transfusion-associated risks. Most importantly, the authors also report a significant reduction in acute renal failure (RR 0.42, 95% CI 0.20–0.86; P=0.02). Causality cannot be identified by meta-analyses, but acute renal failure has been shown to be associated with a significant increase in long-term mortality in cardiac and noncardiac surgery.5–8

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