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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A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients
Christian F Weber,Dirk Meininger,Eva Herrmann,Tobias M. Bingold,Anton Moritz,Lawrence H. Cohn,Kai Zacharowski +6 more
TL;DR: Hemostatic therapy based on POC testing reduced patient exposure to allogenic blood products and provided significant benefits with respect to clinical outcomes.
Journal ArticleDOI
Analyzing coagulation dynamics during treatment of vascular malformations with thromboelastography.
Joana M. Mack,Joana M. Mack,C D'ann Pierce,Gresham T. Richter,Gresham T. Richter,Beverly J. Spray,Richard W. Nicholas,Richard W. Nicholas,P. Spencer Lewis,P. Spencer Lewis,David L. Becton,David L. Becton,Shelley E. Crary,Shelley E. Crary +13 more
TL;DR: It is hypothesized that patients with slow‐flow vascular malformations will have changes in TEG parameters peri‐procedure that will help predict blood product or medication administration.
Journal ArticleDOI
Surveillance de l'anticoagulation des circulations extracorporelles par l'héparine non fractionnée : quels sont les problèmes non résolus ?
TL;DR: This critical review presents the current available data on heparin anticoagulation and monitoring in this specific context, and underlines the pending issues about antICOagulation management during extracorporeal bypass.
Journal ArticleDOI
Intensive Care Management of Patients with Cirrhosis
TL;DR: Large studies evaluating the management of patients in the intensive care setting are lacking and most recommendations are based on extrapolation of data from studies in cirrhosis outside of the ICU or by applying general critical care principles which may or may not be appropriate for the critically ill cirrhotic patient.
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.