Blood loss in infants and children for open heart operations: albumin 5% versus Fresh-Frozen plasma in the prime

Oliver, William C.; Beynen, Froukje M.; Nuttall, Gregory A.; Schroeder, Darrell R.; Ereth, Mark H.; Dearani, Joseph A.; Puga, Francisco J.

doi:10.1016/s0003-4975(02)04991-3

Cited by 61 publications

(46 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(10) aPTT is also affected by hemodilution in infants on extracorporeal support. (11) For these reasons, aPTT is likely to be used more in adult, rather than neonatal and pediatric centers.…”

Section: Discussionmentioning

confidence: 99%

Variability in Anticoagulation Management of Patients on Extracorporeal Membrane Oxygenation

Bembea

Annich

Rycus³

et al. 2013

Pediatric Critical Care Medicine

345

356

View full text Add to dashboard Cite

Objective The objective of this study was to determine current practices of anticoagulation in patients on extracorporeal membrane oxygenation (ECMO). Design Internet-based cross-sectional survey distributed between November 2010 – May 2011. Setting Extracorporeal Life Support Organization (ELSO)-registered ECMO centers internationally. Participants ECMO medical directors and coordinators. Interventions None. Measurements and Main Results There were 121 responses from ECMO medical directors and coordinators at 187 ELSO centers with access to the survey. Eight-four of 117 (72%) respondents reported having a written institutional ECMO protocol for both anticoagulation and blood product management at their institution. Sixty-nine of 117 (59%) respondents reported use of tip-to-tip or partially heparin-bonded circuits. Unfractionated heparin was used at all centers; only 8% of respondents indicated use of alternative anticoagulation medications in the 6 months prior to the survey. The preferred method of anticoagulation monitoring was the serial measurement of activated clotting time (ACT), as reported by 97% of respondents. In this survey, 82% of respondents reported antithrombin III (ATIII) testing, 65% reported anti-factor Xa testing, and 43% reported use of thromboelastography during ECMO. Goal ranges for these three tests and interventions triggered by out-of-range values were found to be variable. Conclusions ECMO anticoagulation management policies vary widely by center. The majority of ECMO programs employ ACT as the preferred anticoagulation monitoring tool. The coagulation system is also monitored using more specific markers such as ATIII, anti-factor Xa and thromboelastography by a large number of centers. Future research is needed to elucidate optimal anticoagulation management and improve outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Variability in Anticoagulation Management of Patients on Extracorporeal Membrane Oxygenation

Bembea

Annich

Rycus³

et al. 2013

Pediatric Critical Care Medicine

345

356

View full text Add to dashboard Cite

show abstract

“…It thus builds an important rationale for primary FFP application, although results of a recent systematic review have not revealed persuasive evidence for this approach so far. 25 Regarding the situation in patients undergoing pCFS, only few data on the administration of FFPs and its consequences on perioperative haemorrhage are available. Williams et al 5 performed a prospective study in which they performed analyses on various coagulation parameters during pCFS.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Pilot Study of Fresh Frozen Plasma versus Human Albumin in Paediatric Craniofacial Repair

et al. 2008

View full text Add to dashboard Cite

Paediatric craniofacial surgery (pCFS) regularly requires transfusion of packed red blood cells (pRBC). In this clinical pilot study two different transfusion regimens were prospectively compared concerning pRBC transfusions, postoperative bleeding and other clinical parameters. Thirty infants (aged < 12 months) scheduled for pCFS were assigned to receive fresh frozen plasma (FFP-group, n = 15) or 5% human albumin (HA-group, n = 15) during the entire surgical procedure. Perioperative amounts of pRBC, postoperative bleeding, major complications, duration of stay in the intensive care unit and overall hospital stay were compared. Differences in pRBC transfusions, postoperative bleeding, and duration of intensive care unit stay were not significant and no major complications occurred in either group. A significantly shorter overall hospital stay was observed in favour of the FFP-group. Volume replacement during pCFS can be safely performed with both applied protocols. Our data do not demonstrate a major advantage for FFP use, but further evaluation is necessary.

show abstract

“…8,24,30,45 None of these trials convincingly demonstrated that the prophylactic administration of a therapeutic dose of plasma reduced blood loss and red blood cell transfusion. Similarly, retrospective studies examining the ability of the PT or INR to predict hemorrhage at the time of invasive procedures have failed to show a correlation between the INR and hemorrhagic outcomes.…”

mentioning

confidence: 99%

Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy

Matevosyan¹,

Madden²,

Barnett³

et al. 2011

JNS

View full text Add to dashboard Cite

H emostasis is a complex interaction among 1) the fluid phase of procoagulants that generate thrombin, 2) the natural anticoagulants that regulate thrombin, 3) the fibrinolytic system that controls the size of thrombus and maintains vascular patency, and 4) the cellular phase that includes platelets and endothelium. To date, no single global test exists to assess these 4 components of hemostasis. The in vitro coagulation tests, the PT and PTT, were developed to identify the cause of bleeding in a symptomatic bleeding patient; they have never been shown to assess the risk of bleeding in a nonbleeding patient. 16,20,35 Because different sensitivities of tissue thromboplastin reagents account for the variability of PT, the INR was introduced to monitor warfarin therapy. The INR is a calculated value derived by the following formula: (patient PT/mean normal PT) ISI , where ISI is a value assigned to the PT reagent when compared with a WHO reference standard with an ISI of 1.0. 31,43,44 The INR was standardized on plasmas from patients on chronic warfarin therapy that affects only VKD factors II, VII, IX, and X. Use of the INR is therefore inappropriate in other medical conditions in which clotting factors other than VKD factors are affected.10 However, the INR is often (mis)used in clinical practice to assess hemostasis in patients not receiving warfarin therapy; thus, patients with mildly elevated INRs are reflexively transfused with FFP, usually perioperatively.In the past, less-sensitive thromboplastin reagents (ISI > 2.0) caused a prolonged PT only when factor VII Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy Object. Neurosurgical patients often have mildly prolonged prothrombin time (PT) or international normalized ratio (INR). In the absence of liver disease this mild prolongation appears to be due to the use of very sensitive PT reagents. Therefore, the authors performed relevant coagulation factor assays to assess coagulopathy in such patients. They also compared plasma transfusion practices in their hospital before and after the study.Methods. The authors tested 30 plasma specimens from 25 patients with an INR of 1.3-1.7 for coagulation factors II, VII, and VIII. They also evaluated plasma orders during the 5-month study period and compared them with similar poststudy periods following changes in plasma transfusion guidelines based on the study results.Results. At the time of plasma orders the median INR was 1.35 (range 1.3-1.7, normal reference range 0.9-1.2) with a corresponding median PT of 13.6 seconds (range 12.8-17.6 seconds). All partial thromboplastin times were normal (median 29.0 seconds, range 19.3-33.7 seconds). The median factor VII level was 57% (range 25%-124%), whereas the hemostatic levels recommended for major surgery are 15%-25%. Factors II and VIII levels were also within the hemostatic range (median 72% and 118%, respectively). Based on these scientific data, plasma transfusion guidelines were mod...

show abstract

Blood loss in infants and children for open heart operations: albumin 5% versus Fresh-Frozen plasma in the prime

Cited by 61 publications

References 27 publications

Variability in Anticoagulation Management of Patients on Extracorporeal Membrane Oxygenation

Variability in Anticoagulation Management of Patients on Extracorporeal Membrane Oxygenation

A Clinical Pilot Study of Fresh Frozen Plasma versus Human Albumin in Paediatric Craniofacial Repair

Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy

Contact Info

Product

Resources

About