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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Journal ArticleDOI
Laboratory point-of-care monitoring in the operating room
Amanda J Rhee,Ronald A Kahn +1 more
TL;DR: POCT, although generally found to be more expensive compared to laboratory testing, has been shown to quicken result time and will continue to be useful in the realm of anesthesiology in management of the surgical patient to guide drug therapy, surgical strategy, and medical management.
Journal ArticleDOI
Thrombelastometry guided blood-component therapy after cardiac surgery: a randomized study
Martin Haensig,Joerg Kempfert,Pia-Maria Kempfert,Evaldas Girdauskas,Michael A. Borger,Sven Lehmann +5 more
TL;DR: In patients with long CPB-times ROTEM®-guided treatment may result in less bleeding, a marked reduction in costs and long-term mortality, and a treatment algorithm based on “point-of-care” 4-chamber ROTems seems to be at least as effective as standard therapy.
Journal Article
Evaluation of post-cardiopulmonary bypass coagulation disorders by differential diagnosis with a multichannel modified thromboelastogram: a pilot investigation.
TL;DR: Therapy based on the synoptic modified multichannel thromboelastogram analysis provides a guide for effective therapy of coagulopathy, however, elaboration is desirable, and larger clinical trials are necessary for a final evaluation of the protocol.
Journal ArticleDOI
Perioperative use of the Thrombelastograph in patients with inherited bleeding disorders.
TL;DR: Three surgical patients are presented with von Willebrand's disease, factor XII deficiency, and hemophilia A with dysfibrinogenemia in which the abnormalities detected by the TEG were similar to the expected coagulation abnormalities based on preoperative laboratory studies.
Patent
Method and apparatus for hemostasis and blood management
Eli Cohen,Irene A. Navickas +1 more
Abstract: A procedure for hemostasis and blood management, particularly for cardiovascular procedures, provides: sampling instructions, i.e., when to draw blood samples and how to pre-treat the blood samples, a decision tree to assist the interpretation of hemostasis analysis results allowing for the identification of various coagulopathies, and treatment suggestions related to the hemostasis analysis results. The analysis, interpretation and identification may be conducted by a suitably programmed computer.
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
TL;DR: Significant variability in institutional transfusion practice was observed for allogeneic packed red blood cells (PRBCs) and hemostatic blood components and for patients at institutions with liberal rather than conservative transfusions practice.
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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
TL;DR: It is demonstrated that high- and low-dose aprotinin significantly reduces the requirement for donor-blood transfusion in repeat CABG patients without increasing the risk for perioperative MI.
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.