Abstract

The present case was to show the efficacy of implementing routine intra operative parallel rotational thromboelastometry (ROTEM) assays immediately after cardiopulmonary bypass (CPB) in diagnosis and management of unexpected post-CPB bleeding diathesis in cardiac and major vascular surgery. A 54-year-old male gone under an elective aortic valve repair and graft interposition procedure. The routine INTEM, EXTEM, FIBTEM, and APTEM assays started immediately after CPB and protamine administration showed tracings indicating hyperfibrinolysis and hypofibrinogenemia. Tranexamic acid was administered intravenously within 30 minutes the start of the ROTEM assay and transfusion of cryoprecipitate was decided. The implementation of routine intra operative parallel ROTEM assays immediately after CPB enabled earlier determination of unexpected post-CPB bleeding diathesis due to hyperfibrinolysis and hypofibrinogenemia and facilitated timely and appropriate coagulation management in cardiac and major vascular surgery.