Comparison of Coagulation Parameters in Arterial and Venous Blood in Cardiac Surgery Measured Using the Quantra System

• Published in: Journal of cardiothoracic and vascular anesthesia 2019-04, Vol.33 (4), p.976-984
• Main Authors: Groves, Danja S., Winegar, Deborah A., Fernandez, Lucas G., Huffmyer, Julie L., Viola, Francesco
• Format: Article
• Language: English
• Subjects: Aged; arterial blood; Blood Coagulation - physiology; Blood Coagulation Tests - methods; Blood Coagulation Tests - standards; Blood Specimen Collection - methods; Blood Specimen Collection - standards; cardiac surgery; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - standards; coagulation testing; Female; Humans; Male; Middle Aged; Monitoring, Intraoperative - methods; Monitoring, Intraoperative - standards; Pilot Projects; Prospective Studies; Quantra System; venous blood
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2018.08.201

Perioperative coagulation testing often is performed with arterial samples even though device reference ranges typically are established in venous samples. Although limited studies exist comparing coagulation parameters across sampling sites, viscoelastic testing devices have demonstrated some differences. The objective of this study was to compare coagulation parameters determined using the Quantra System for venous and arterial samples. Prospective, observational study. Tertiary care university hospital. The study comprised 30 adult patients undergoing cardiac surgery. Paired arterial and venous samples were obtained at 2 of the following time points: baseline, during bypass, or after protamine reversal of heparin. Quantra measurements included Clot Time (CT), Heparinase Clot Time (CTH), Clot Time Ratio (CTR), Clot Stiffness (CS), and Fibrinogen (FCS) and Platelet (PCS) Contributions to clot stiffness. The relationship and agreement between matched data pairs were established and statistical analysis was performed via paired t tests. CTR, CS, FCS, and PCS were unaffected by the sampling site, whereas CT and CTH demonstrated statistically significant differences between arterial and venous samples (p < 0.001). Arterial clot times were prolonged relative to the venous ones with a mean percent error of 14.2 % and 11.9 %, respectively. These results are in general agreement with those reported for other viscoelastic testing devices. This study demonstrates that Quantra clot stiffness-based parameters (CS, FCS, PCS) are unaffected by sampling site, whereas the clot time parameters (CT and CTH) show good correlation in the presence of a bias. CTR, a ratio of CT and CTH, also is unaffected.