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Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies Evaluating Point-of-Care Tests of Coagulopathy in Cardiac Surgery

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posted on 2021-07-13, 14:08 authored by MJ Woźniak, R Abbasciano, A Monaghan, FY Lai, C Corazzari, C Tutino, T Kumar, P Whiting, GJ Murphy
Treatment guidelines recommend the routine use of point-of-care diagnostic tests for coagulopathy in the management of cardiac surgery patients at risk of severe bleeding despite uncertainty as to their diagnostic accuracy. We performed a systematic review and meta-analysis of studies that evaluated the diagnostic accuracy of viscoelastometry, platelet function tests, and modified thromboelastography (TEG) tests, for coagulopathy in cardiac surgery patients. The reference standard included resternotomy for bleeding, transfusion of non-red cell components, or massive transfusion. We searched MEDLINE, EMBASE, CINAHL, and Clinical Trials.gov, from inception to June 2019. Study quality was assessed using QUADAS-2. Bivariate models were used to estimate summary sensitivity and specificity with (95% confidence intervals). All 29 studies (7440 participants) included in the data synthesis evaluated the tests as predictors of bleeding. No study evaluated their role in the management of bleeding. None was at low risk of bias. Four were judged as low concern regarding applicability. Pooled estimates of diagnostic accuracy were; Viscoelastic tests, 12 studies, sensitivity 0.61 (0.44, 0.76), specificity 0.83 (0.70, 0.91) with significant heterogeneity. Platelet function tests, 12 studies, sensitivity 0.63 (0.53, 0.72), specificity 0.75 (0.64, 0.84) with significant heterogeneity. TEG modification tests, 3 studies, sensitivity 0.80 (0.67, 0.89), specificity 0.76 (0.69, 0.82) with no evidence of heterogeneity. Studies reporting the highest values for sensitivity and specificity had important methodological limitations. In conclusion, we did not demonstrate predictive accuracy for commonly used point-of-care devices for coagulopathic bleeding in cardiac surgery. However, the certainty of the evidence was low.

Funding

British Heart Foundation (CH/12/1/29419)

Leicester NIHR Biomedical Research Centre

History

Citation

Transfusion Medicine Reviews Volume 35, Issue 1, January 2021, Pages 7-15

Author affiliation

Department of Cardiovascular Sciences

Version

  • AM (Accepted Manuscript)

Published in

Transfusion Medicine Reviews

Volume

35

Issue

1

Pagination

7 - 15

Publisher

Elsevier

issn

0887-7963

eissn

1532-9496

Acceptance date

2020-09-19

Copyright date

2020

Available date

2021-10-29

Spatial coverage

United States

Language

English

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