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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Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.
TL;DR: The present overview summarizes the challenges faced by the anaesthesiologist regarding the pathophysiological alterations during the Cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy in the preoperative, intraoperative and postoperative periods.
Journal ArticleDOI
Goal-directed transfusion protocol via thrombelastography in patients with abdominal trauma: a retrospective study
Jianyi Yin,Zhenguo Zhao,Yousheng Li,Jian Wang,Danhua Yao,Shaoyi Zhang,Wenkui Yu,Ning Li,Jieshou Li +8 more
TL;DR: Goal-directed transfusion protocol via standard TEG was achievable in patients with abdominal trauma and has the potential to decrease blood product utilization and prevent exacerbation of coagulation function.
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The evolution of liver transplantation practices.
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TL;DR: Increased multicenter and international collaborative research in perioperative anesthetic care of liver transplant patients is needed to extend this body of knowledge required to improve transplant outcomes.
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Monitoring anticoagulation and hemostasis in cardiac surgery.
TL;DR: The need for rapid and accurate identification of abnormal hemostasis has been the major impetus for the development of point-of-care tests and their use in transfusion algorithms for cardiac surgical and other critically ill patients.
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Blood preservation workshop: new and emerging trends in research and clinical practice.
Jelena L. Holovati,Jelena L. Holovati,Judith Hannon,Judith Hannon,Maria I.C. Gyongyossy-Issa,Maria I.C. Gyongyossy-Issa,Jason P. Acker,Jason P. Acker +7 more
TL;DR: This workshop provided a summary of the advances and challenges that currently face the preservation sciences, together with a glimpse at the future applications and instrumentation that will enhance the ability to process, preserve, and store red blood cells, platelets, and stem cells.
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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.