Association of Perioperative Cryoprecipitate Transfusion and Mortality After Cardiac Surgery

Hinton, Jake V; Xing, Zhongyue; Fletcher, Calvin; Perry, Luke A; Karamesinis, Alexandra; Shi, Jenny; Ramson, Dhruvesh M.; Penny-Dimri, Jahan C.; Liu, Zhengyang; Williams-Spence, Jenni; Coulson, Tim G; Smith, Julian A.; Segal, Reny; Bellomo, Rinaldo

doi:10.1016/j.athoracsur.2023.02.054

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…Hinton et al ( 32 ) analyzed data from the Medical Information Mart for Intensive Care (MIMIC) III and IV databases and found that cryoprecipitate administration after cardiac surgery was infrequent, and postoperative cryoprecipitate transfusion was not significantly associated with AKI (OR: 1.03, 99% CI 0.65–1.62, P = 0.876). Conversely, Jake et al ( 33 ) conducted a study involving 119,132 eligible patients and concluded that postoperative cryoprecipitate transfusion was associated with a reduction in acute kidney injury (OR: 0.85, 99% CI, 0.73–0.98; P = 0.0037). A substantial amount of cryoprecipitate transfusion in cardiac surgery reflects excessive surgical bleeding, resulting in renal hypoperfusion and ischemia, which may be linked to AKI.…”

Section: Discussionmentioning

confidence: 99%

The incidence, risk factors, and prognosis of acute kidney injury in patients after cardiac surgery

Wang,

Bao,

Lan

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAcute kidney injury (AKI) represents a significant complication following cardiac surgery, associated with increased morbidity and mortality rates. Despite its clinical importance, there is a lack of universally applicable and reliable methods for the early identification and diagnosis of AKI. This study aimed to examine the incidence of AKI after cardiac surgery, identify associated risk factors, and evaluate the prognosis of patients with AKI.MethodThis retrospective study included adult patients who underwent cardiac surgery at Changhai Hospital between January 7, 2021, and December 31, 2021. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Perioperative data were retrospectively obtained from electronic health records. Logistic regression analyses were used to identify independent risk factors for AKI. The 30-day survival was assessed using the Kaplan–Meier method, and differences between survival curves for different AKI severity levels were compared using the log-rank test.ResultsPostoperative AKI occurred in 257 patients (29.6%), categorized as stage 1 (179 patients, 20.6%), stage 2 (39 patients, 4.5%), and stage 3 (39 patients, 4.5%). The key independent risk factors for AKI included increased mean platelet volume (MPV) and the volume of intraoperative cryoprecipitate transfusions. The 30-day mortality rate was 3.2%. Kaplan–Meier analysis showed a lower survival rate in the AKI group (89.1%) compared to the non-AKI group (100%, P < 0.001).ConclusionAKI was notably prevalent following cardiac surgery in this study, significantly impacting survival rates. Notably, MPV and administration of cryoprecipitate may have new considerable predictive significance. Proactive identification and management of high-risk individuals are essential for reducing postoperative complications and mortality.

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Section: Discussionmentioning

confidence: 99%

The incidence, risk factors, and prognosis of acute kidney injury in patients after cardiac surgery

Wang,

Bao,

Lan

et al. 2024

Front. Cardiovasc. Med.

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“…The European Society for Anaesthesiology guidelines indicate that a fibrinogen concentration of less than 150 to 200 mg dL −1 is considered hypofibrinogenemic 27 . Treating acquired hypofibrinogenemia earlier shows promise for positive impact in trauma, 28,29 cardiovascular surgery, 30,31 pediatric major surgery, 32 and obstetric hemorrhage, 33 but the ability to provide earlier treatment, or more rapid correction with fibrinogen supplementation, is limited. Until recently, common concentrated sources have had delayed access due to need to thaw cryoprecipitated antihemophilic factor (cryo‐AHF), 34 or the need to reconstitute fibrinogen concentrates, both of which require approximately 5–20 minutes to achieve (cryo‐AHF, COI; Fibryga, Octapharma, Paramus, NJ; and RiaSTAP, CSL Behring, King of Prussia, PA) 34‐37 .…”

Section: Introductionmentioning

confidence: 99%

Analyzing and modeling massive transfusion strategies and the role of fibrinogen—How much is the patient actually receiving?

Keltner,

Cushing,

Haas

et al. 2024

Transfusion

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BackgroundHemorrhage is a leading cause of preventable death in trauma, cardiac surgery, liver transplant, and childbirth. While emphasis on protocolization and ratio of blood product transfusion improves ability to treat hemorrhage rapidly, tools to facilitate understanding of the overall content of a specific transfusion strategy are lacking. Medical modeling can provide insights into where deficits in treatment could arise and key areas for clinical study. By using a transfusion model to gain insight into the aggregate content of massive transfusion protocols (MTPs), clinicians can optimize protocols and create opportunities for future studies of precision transfusion medicine in hemorrhage treatment.MethodsThe transfusion model describes the individual round and aggregate content provided by four rounds of MTP, illustrating that the total content of blood elements and coagulation factor changes over time, independent of the patient's condition. The configurable model calculates the aggregate hematocrit, platelet concentration, percent volume plasma, total grams and concentration of citrate, percent volume anticoagulant and additive solution, and concentration of clotting factors: fibrinogen, factor XIII, factor VIII, and von Willebrand factor, provided by the MTP strategy.ResultsTransfusion strategies based on a 1:1:1 or whole blood foundation provide between 13.7 and 17.2 L of blood products over four rounds. Content of strategies varies widely across all measurements based on base strategy and addition of concentrated sources of fibrinogen and other key clotting factors.DiscussionDifferences observed between modeled transfusion strategies provide key insights into potential opportunities to provide patients with precision transfusion strategy.

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“…[21][22][23][24] Similarly, treating hypofibrinogenemia earlier, although limited by cryo AHF availability, shows promising positive impact on patient outcomes, reducing blood loss, and overall blood component utilization. 12,[25][26][27][28][29] Currently, LAMC does not offer any viscoelastic testing. While its benefits have been discussed, operational challenges have prevented implementation; it is possible that it may be onboarded in the future.…”

Section: Introductionmentioning

confidence: 99%

“…12 In addition to patient safety, excessive bleeding in CV surgery can lead to an increase in cost due to longer operating room (OR) times, patient length of stay, and an increase in blood product utilization. 12,28 While the challenges associated with cryo AHF had been longstanding concerns of LAMC's TS, it was supply constraints in 2021 that prompted implementation of Pathogen Reduced Cryoprecipitated Fibrinogen Complex (also known as INTERCEPT Fibrinogen Complex or IFC) (Figure 1). IFC is approved to treat and control bleeding associated with fibrinogen deficiency.…”

Section: Introductionmentioning

confidence: 99%

How do I implement pathogen reduced Cryoprecipitated fibrinogen complex in a tertiary Hospital's blood Bank

Aidikoff,

Trivedi,

Kwock

et al. 2024

Transfusion

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BackgroundKaiser‐Permanente Los Angeles Medical Center (LAMC) is a 560 licensed bed facility that provides regional cardiovascular services, including 1200 open heart surgeries annually. In 2021, LAMC explored alternative therapies to offset the impact of pandemic‐driven cryo AHF shortages, and implemented Pathogen Reduced Cryoprecipitated Fibrinogen Complex (also known as INTERCEPT Fibrinogen Complex or IFC). IFC is approved to treat and control bleeding associated with fibrinogen deficiency. Unlike cryo AHF, IFC has 5‐day post‐thaw shelf life with potential operational and clinical benefits. The implementation steps and the operational advantages to the LAMC Blood Bank are described.Study Design and MethodsEighteen months post‐implementation, the institution reviewed their product implementation experience and compared IFC with cryo AHF with a retrospective review of transfusion service and cardiac post‐op data.ResultsIFC significantly decreased product wastage rates and order‐to‐issue time. It did not significantly impact post‐op product utilization or hospital length of stay (LOS) in cardiac surgery patients when compared with cryo AHF.DiscussionImplementation of IFC provides improved product supply stability, shorter turnaround times, and reduced wastage.

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Association of Perioperative Cryoprecipitate Transfusion and Mortality After Cardiac Surgery

Cited by 7 publications

References 31 publications

The incidence, risk factors, and prognosis of acute kidney injury in patients after cardiac surgery

The incidence, risk factors, and prognosis of acute kidney injury in patients after cardiac surgery

Analyzing and modeling massive transfusion strategies and the role of fibrinogen—How much is the patient actually receiving?

How do I implement pathogen reduced Cryoprecipitated fibrinogen complex in a tertiary Hospital's blood Bank

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