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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Factor XIII Deficiency and Thrombocytopenia Are Frequent Modulators of Postoperative Clot Firmness in a Surgical Intensive Care Unit.
TL;DR: Postoperative clot firmness as evaluated by whole blood thrombelastometry (ROTEM EXTEM assay) is independently and frequently modulated though FXIII activity and the platelet count, while fibrinogen concentration is also an independent but much less frequent modulator.
Journal ArticleDOI
Consistency of thromboelastometry analysis under scrutiny: Results of a systematic evaluation within and between analysers
Michael Nagler,Hugo ten Cate,Silvio Kathriner,Mattias Casutt,Lucas M. Bachmann,Walter A. Wuillemin +5 more
TL;DR: Clinicians and scientists should take these inconsistencies into account and focus on parameters with a higher homogeneity such as MCF, but none of the tests assessed outperformed another.
Patent
Protocol and apparatus for determining heparin-induced thrombocytopenia
TL;DR: A hemostasis analyzer, such as the Thrombelastograph® (TEG®) analyzer is utilized to measure continuously in real-time, the process from the initial fibrin formation, through platelet-fibrin interaction and lysis to generate blood he mostasis parameters as mentioned in this paper, which permit determination of heparin-induced thrombocytopenia II complex (HiT II).
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The effect of fresh frozen plasma in critically ill patients.
TL;DR: The aim of this study was to investigate the effect of FFP transfusion judged by a wide range of coagulation tests.
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Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries†
TL;DR: Investigating key elements of preoperative evaluations, intraoperative management, and early postoperative care that might significantly affect costs in order to develop a best‐value approach for new programs in resource‐limited health systems concludes that some costly techniques and treatments can be omitted without adverse effects on outcomes.
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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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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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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.