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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Foundation/American Heart Association Task Force on Practice Guidelines Executive Summary : A Report of the American College of Cardiology 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery:
Michael D. Winniford,John D. Puskas,Joseph F. Sabik,Ola A. Selnes,David M. Shahian,Stephen J. Lahey,Richard A. Lange,Martin J. London,Michael J. Mack,Loren F. Hiratzka,Adolph M. Hutter,Michael E. Jessen,Ellen C. Keeley,John A. Bittl,Charles R. Bridges,John G. Byrne,Joaquin E. Cigarroa,L.David Hillis,Peter K. Smith,Jeffrey L. Anderson +19 more
TL;DR: A report of the American College of Cardiology 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the African American Heart Association Task Force on Practice Guidelines Executive Summary.
Journal ArticleDOI
Blood utilization in revision versus first-time cardiac surgery: an update in the era of patient blood management.
Nadia B. Hensley,Megan P. Kostibas,William W. Yang,Todd C. Crawford,Kaushik Mandal,Pranjal B. Gupta,Steven M. Frank,Charles H. Brown +7 more
TL;DR: This study was performed as an update to determine if this finding of increased transfusion requirements in revision cardiac surgery is still evident in the PBM era.
Journal ArticleDOI
Transfused stored platelets have the same haemostatic function as circulating native platelets.
Wilfried W. H. Roeloffzen,Hanneke C. Kluin-Nelemans,Nic J. G. M. Veeger,Lotte Bosman,J. Th. M. De Wolf +4 more
TL;DR: This instrument was used to study whether transfused platelets (PLTs) have the same haemostatic function compared to native circulating PLTs and the effect of storage time on the haemOSTatic potential of platelet concentrates (PCs).
Journal ArticleDOI
Practical management of anticoagulation, bleeding and blood product support for cardiac surgery Part one: Bleeding and anticoagulation issues
TL;DR: Cardiothoracic surgeons, anaesthetists, perfusionists and haematologists can ensure 'best practice' by being actively involved in the development of 'local' transfusion and anticoagulation guidelines, hospital transfusion committee policies, and audits.
Journal ArticleDOI
Liver transplantation and risk of bleeding.
TL;DR: Differences in perioperative blood loss, transfusion criteria and intraoperative management of coagulation may account for the interhospital variations in transfusion of red blood cells during orthotopic liver transplantation.
References
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Designed extension of studies based on conditional power
TL;DR: In this paper, a flexible method of extending a study based on conditional power is proposed, where the significance of the treatment difference at the planned end is used to determine the number of additional observations needed and the critical value necessary for use after accruing those additional observations.
Journal ArticleDOI
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.
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
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.