Use of thromboelastography to monitor effects of the hemocoagulase on the blood coagulation in patients after thoracic surgery.

BACKGROUND: Over the past few years, snake venom thrombin-like preparations which possess the advantages of low toxicity, fast onset, and long-lasting efficacy have been commonly used as hemostatic drugs in clinical surgery. However, recently, cases of hypofibrinogenemia and bleeding after using the hemocoagulase have been reported and cannot be ignored. Our study used thromboelastography (TEG) to monitor the hemocoagulase effects of blood coagulation status in patients after thoracic surgery.

METHODS: Patients suffering thoracic surgery in the First Affiliated Hospital of Soochow University between June 2018 and June 2019 were selected and grouped based on the results of postoperative TEG. The patients with low coagulation index (CI) detected by the TEG were set as the low CI group, and randomly selected patients with normal CI were set as the control group and matched in gender, age, and disease type with patients in the low CI group. The general condition, disease type, preoperative blood coagulation routine, type of hemocoagulase used, postoperative blood coagulation status, and blood transfusion status of the two groups were separately analyzed.

RESULTS: The preoperative fibrinogen (FIB) content in the low CI group was significantly lower than that in the control group (P<0.01). Of the 43 patients, 41 had no bleeding according to indicators like increased drainage. Two had a bleeding tendency, and were thus clinically discontinued from hemocoagulase and supplemented with FIB, fresh frozen plasma, and cryoprecipitate; their drainage volume was significantly reduced, and reexamination of TEG showed normal coagulation status.

CONCLUSIONS: For patients with preoperative low FIB or a lower limit of normal value, hemocoagulase should be used with caution; after using this type of thrombin, applying TEG for the timely monitoring of a patient's coagulation status is optimally recommended.