Journal ArticleDOI
Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery.
Linda Shore-Lesserson,HE Manspeizer,Marietta DePerio,S Francis,Frances Vela-Cantos,M A Ergin +5 more
TLDR
Point-of-care coagulation monitoring using TEG resulted in fewer transfusions in the postoperative period, and this data support the use of TEG in an algorithm to guide transfusion therapy in complex cardiac surgery.Abstract:
Transfusion therapy after cardiac surgery is empirically guided, partly due to a lack of specific point-of-care hemostasis monitors. In a randomized, blinded, prospective trial, we studied cardiac surgical patients at moderate to high risk of transfusion. Patients were randomly assigned to either a thromboelastography (TEG)-guided transfusion algorithm (n 5 53) or routine transfusion therapy (n 5 52) for intervention after cardiopulmonary bypass. Coagulation tests, TEG variables, mediastinal tube drainage, and transfusions were compared at multiple time points. There were no demographic or hemostatic test result differences between groups, and all patients were given prophylactic antifibrinolytic therapy. Intraoperative transfusion rates did not differ, but there were significantly fewer postoperative and total transfusions in the TEG group. The proportion of patients receiving freshfrozen plasma (FFP) was 4 of 53 in the TEG group compared with 16 of 52 in the control group (P , 0.002). Patients receiving platelets were 7 of 53 in the TEG group compared with 15 of 52 in the control group (P , 0.05). Patients in the TEG group also received less volume of FFP (36 6 142 vs 217 6 463 mL; P , 0.04). Mediastinal tube drainage was not statistically different 6, 12, or 24 h postoperatively. Point-of-care coagulation monitoring using TEG resulted in fewer transfusions in the postoperative period. We conclude that the reduction in transfusions may have been due to improved hemostasis in these patients who had earlier and specific identification of the hemostasis abnormality and thus received more appropriate intraoperative transfusion therapy. These data support the use of TEG in an algorithm to guide transfusion therapy in complex cardiac surgery. Implications: Transfusion of allogeneic blood products is common during complex cardiac surgical procedures. In a prospective, randomized trial, we compared a transfusion algorithm using point-of-care coagulation testing with routine laboratory testing, and found the algorithm to be effective in reducing transfusion requirements. (Anesth Analg 1999;88:312‐9)read more
Citations
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Book ChapterDOI
Chapter 41 – Point-of-Care Testing for Hemostatic Disorders
Kendra Kubiak,B. Gail Macik +1 more
Patent
SYSTEMIC PRO-HEMOSTATIC EFFECT OF CLOTTING FACTORS IN COMBINATION WITH SYMPATHICOMIMETICS WITH AGONISTIC EFFECTS ON a-ADRENERGIC AND/OR ss-ADRENERGIC RECEPTORS OF THE SYMPATHETIC NERVOUS SYSTEM, RELATED TO IMPROVED CLOT STRENGTH.
TL;DR: In this article, a novel use and methods of treatment using the combination of clotting factors and sympathicomimetic / adrenergic receptor agonists with pro-hemostatic activity was described.
Book ChapterDOI
Perioperative Management of LVAD Patients
TL;DR: This chapter reviews the critical components of effective post operative care, and troubleshooting for the newly implanted CF-LVAD patient.
Journal ArticleDOI
Thromboelastography as a guide for transfusion therapy in a patient with Turner's syndrome, hypoplasia of the aortic arch and aortic coarctation, undergoing aortoplasty with «sliding technique»: Case report
Andrea Carolina Pérez Pradilla,Orlando Tamariz-Cruz,Luis Gerardo Motta Amézquita,Marcela Barrera Fuentes,Alexis Palacios Macedo Quenot +4 more
TL;DR: A case of an 8 years and 9 months old girl with Turner’s syndrome, aortic coarctation and aortIC arch hypoplasia who was admitted for sliding arch aortoplasty and received thromboelastography guided transfusion therapy is presented.
References
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Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines A 24-Institution Study
E. P. Stover,Lawrence C. Siegel,R. Parks,Jack Levin,Simon C. Body,Rosemarie Maddi,Michael N. D'Ambra,Dennis T. Mangano,Bruce D. Spiess +8 more
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Journal ArticleDOI
A Multicenter, Double-Blind, Placebo-Controlled Trial of Aprotinin for Reducing Blood Loss and the Requirement for Donor-Blood Transfusion in Patients Undergoing Repeat Coronary Artery Bypass Grafting
Jerrold H. Levy,Roque Pifarre,Hartzell V. Schaff,Jan C. Horrow,Robert Albus,Bruce D. Spiess,Todd K. Rosengart,Jeffrey C. Murray,Richard E. Clark,Peter K. Smith,Andrea Nadel,Sharon L. Bonney,Robert Kleinfield +12 more
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Journal ArticleDOI
Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients
TL;DR: Use of TEG monitoring before reexploration has decreased the cost and potential risk for patients undergoing CABG surgery and the incidence of reoperation for hemorrhage.
Journal ArticleDOI
Prophylactic tranexamic acid decreases bleeding after cardiac operations.
Jan C. Horrow,J. Hlavacek,Michael D. Strong,W. Collier,Isadore Brodsky,S.M. Goldman,I.P. Goel +6 more
TL;DR: It is concluded that prophylactic tranexamic acid can be administered safely to inhibit fibrinolysis during cardiac operations, decrease postoperative bleeding, and possibly decrease the frequency of blood product transfusion.