2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines

Ferraris, Victor A.; Brown, Jeremiah R.; Despotis, George J.; Hammon, John W.; Reece, T. Brett; Saha, Sibu P.; Song, Howard K.; Clough, Ellen R.; Shore‐Lesserson, Linda; Goodnough, Lawrence T.; Mazer, C. David; Shander, Aryeh; Stafford‐Smith, Mark; Waters, Jonathan H.; Baker, Robert A.; Dickinson, Timothy A.; Fitzgerald, Daniel J.; Likosky, Donald S.; Shann, Kenneth G.

doi:10.1016/j.athoracsur.2010.11.078

Cited by 1,149 publications

(884 citation statements)

References 370 publications

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“…A protocol was developed (eAppendix pg 21) that was restricted to RCTs and observational studies of transfusion in cardiac surgery, but because current transfusion guidelines 4,5 are also based on RCTs in non-cardiac surgical patients, we subsequently decided to include these in this systematic review. Despite the limitations of comparing different study designs, we chose to compare RCTs and observational studies as these are the evidence base for current guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…The decision to transfuse is complicated by several factors; severe anaemia and excessive blood loss are common in this setting 1,2 , and patients with cardiovascular disease have different transfusion requirements to other patient groups 3 . Transfusion decisions in cardiac surgery are most commonly based on the severity of perioperative anaemia: guidelines currently recommend (Grade C recommendation) highly restrictive transfusion thresholds with Haemoglobin (Hb) concentrations of 6-7g/dL 4,5 . These are based largely on the results of RCTs in non-cardiac surgery patients that indicate equivalence for restrictive transfusion thresholds [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

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Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis

Patel

Avlonitis

Jones

et al. 2015

The Lancet Haematology

112

106

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(2015). Indications for red blood cell transfusion in cardiac surgery: A systematic review and meta-analysis. Lancet Haematology, 2(12), e543-e553. DOI: 10.1016/S2352-3026 (15) University of Bristol -Explore Bristol Research General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available:

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis

Patel

Avlonitis

Jones

et al. 2015

The Lancet Haematology

112

106

View full text Add to dashboard Cite

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“…Current practice guidelines support incorporating near‐patient coagulation testing into blood management algorithms for cardiac surgery 24, 25, 26. However, these guidelines do not distinguish between the use of near‐patient tests to inform treatment selection after patients develop severe bleeding, and the use of pre‐emptive testing to predict bleeding and to direct preventative treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Blood management algorithms incorporating near‐patient tests are recommended in US and European practice guidelines24, 25, 26, and are used widely 27. However, there is poor consensus about the best algorithm design, particularly whether near‐patient tests should be performed in response to severe bleeding, or whether there is additional value in pre‐emptive testing to help prevention of bleeding.…”

Section: Introductionmentioning

confidence: 99%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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“…Guidelines currently recommend that P2Y12 inhibitor therapy should be held for at least 5 days for clopidogrel or ticagrelor and 7 days for prasugrel before surgery (Class I, Levels of Evidence B and C, respectively). However, the guidelines also provide the recommendation that it is reasonable to perform surgery before these time points, and perhaps as early as 3 days from discontinuation 1, 15. These guidelines stem from the inherent properties of each medication, including their metabolism and clearance.…”

Section: Introductionmentioning

confidence: 99%

To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? That is the Question

Lowenstern

Newby

2017

JAHA

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2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines

Cited by 1,149 publications

References 370 publications

Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis

Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? That is the Question

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