Journal ArticleDOI
The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery.
TLDR
The high negative predictive value of two point-of-care tests supports early identification and targeted treatment of surgical bleeding by distinguishing it from a significant coagulopathy after routine cardiac surgery.Abstract:
Hemorrhage after cardiopulmonary bypass (CPB) remains a clinical problem. Point-of-care tests to identify hemostatic disturbances at the bedside are desirable. In the present study, we evaluated the predictive value of two point-of-care tests on postoperative bleeding after routine cardiac surgery. Prospectively, 255 consecutive patients were studied to compare the ability of modified thromboelastography (ROTEG) as well as a platelet function analyzer (PFA-100) to predict postoperative blood loss. Measurements were performed at three time points: preoperatively, during CPB, and after protamine administration with three modified thromboelastography and PFA tests. The best predictors of increased bleeding tendency were the tests performed after CPB. The angle alpha is the best predictor (area under the receiver operating characteristic curve 0.69) and, in combination with the adenosine diphosphate-PFA test, the predictive accuracy is enhanced (area under the receiver operating characteristic curve 0.73). The negative predictive value for the angle alpha is 82%, although the positive predictive value is small (41%). Thromboelastography is a better predictor than PFA. In routine cardiac surgery, impaired hemostasis as identified by point-of-care tests does not inevitably lead to hemorrhage postoperatively. However, patients with normal test results are unlikely to bleed for hemostatic reasons. Bleeding in these patients is probably caused surgically. The high negative predictive value supports early identification and targeted treatment of surgical bleeding by distinguishing it from a significant coagulopathy. IMPLICATIONS: Thrombelastography and platelet function analysis in routine cardiac surgery demonstrate high negative predictive values for postoperative bleeding, which supports early identification and targeted treatment of surgical bleeding by distinguishing it from a significant coagulopathy. The positive predictive values are small. The best predictors are thrombelastography values obtained after cardiopulmonary bypass.read more
Citations
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Journal ArticleDOI
In vitro: Response of plant growth regulators and antimalformins on conidia germination of Fusarium mangiferae and incidence of mango malformation
TL;DR: The present findings do not authenticate the involvement of F. mangiferae in the disease, however hormonal imbalance, most probably ethylene, might be responsible for deformed functional morphology of panicle and a signal transduction mechanism of stress-stimulated ethylene imbalance causing physio-morphological changes in reproductive organs of mango flower and thereby failure of fertilization and fruit set needs to be investigated.
Journal ArticleDOI
The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients
Maria Rosa Costanzo,Anne I. Dipchand,Randall C. Starling,Allen S. Anderson,Michael Chan,Shashank Desai,Savitri Fedson,Patrick W. Fisher,Gonzalo Gonzales-Stawinski,Luigi Martinelli,David C. McGiffin,Jon Smith,David O. Taylor,Bruno Meiser,Steven A. Webber,David A. Baran,Michael P. Carboni,Thomas J. Dengler,David L. Feldman,Maria Frigerio,Abdallah G. Kfoury,Daniel Kim,Jon A. Kobashigawa,Michael A. Shullo,Josef Stehlik,Jeffrey J. Teuteberg,Patricia A. Uber,Andreas Zuckermann,Sharon A. Hunt,Michael Burch,Geetha Bhat,Charles E. Canter,Richard E. Chinnock,Marisa G. Crespo-Leiro,Reynolds M. Delgado,Fabienne Dobbels,Kathleen L. Grady,W. Kao,Jaqueline Lamour,Gareth Parry,Jignesh Patel,Daniela Pini,Jeffrey A. Towbin,Gene Wolfel,Diego H. Delgado,Howard J. Eisen,Lee R. Goldberg,Jeff Hosenpud,Maryl R. Johnson,Anne Keogh,Clive Lewis,John B. O'Connell,Joseph G. Rogers,Heather J. Ross,Stuart D. Russell,Johan Vanhaecke,Amanda W. Rowe +56 more
TL;DR: Institutional Affiliations Chair Costanzo MR: Midwest Heart Foundation, Lombard Illinois, USA Task Force 1 Dipchand A: Hospital for Sick Children, Toronto Ontario, Canada; Starling R: Cleveland Clinic Foundation, Cleveland, Ohio, USA; Starlings R: University of Chicago, Chicago, Illinois,USA; Chan M: university of Alberta, Edmonton, Alberta, Canada ; Desai S: Inova Fairfax Hospital, Fairfax, Virginia, USA.
Journal ArticleDOI
Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology
Sibylle A. Kozek-Langenecker,Arash Afshari,Pierre Albaladejo,Cesar Aldecoa Alvarez Santullano,Edoardo De Robertis,Daniela Filipescu,Dietmar Fries,Thorsten Haas,Georgina Imberger,Matthias Jacob,Marcus D. Lancé,Juan V. Llau,Susan Mallett,Jens Meier,Niels Rahe-Meyer,Charles Marc Samama,Andrew Smith,Cristina Solomon,Philippe Van der Linden,Anne Wikkelsø,Patrick Wouters,Piet Wyffels +21 more
TL;DR: These guidelines are intended to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible.
Journal ArticleDOI
Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices
Michael T. Ganter,C. K. Hofer +1 more
TL;DR: Viscoelastic POC coagulation devices may help identify the cause of bleeding and guide pro- and anticoagulant therapies, and in diagnosing of a surgical bleeding.
Journal ArticleDOI
Multi-centre investigation on reference ranges for ROTEM thromboelastometry
Thomas Lang,Anne Bauters,Siegmund Braun,Bernd Pötzsch,Klaus-Werner von Pape,Hans-Jürgen Kolde,Meret Lakner +6 more
TL;DR: The data showed that ROTEM thromboelastometry yields consistent values between centres and that providing general orientating reference ranges seems to be possible, and correlated weakly with a trend towards enhanced coagulation in females compared with males and in advanced age.
References
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Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines A 24-Institution Study
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Journal ArticleDOI
Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients
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