Blood transfusion in coronary artery surgery: focus on modifiable risk factors

Petričević, Mate; Biočina, Bojan; Habeković, Renata; Miličić, Davor

doi:10.1093/ejcts/ezt222

Cited by 2 publications

(1 citation statement)

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“…14 Preoperative bleeding risk assessment as well as targeted transfusion of procoagulant blood components may help minimize early postoperative bleeding and transfusion requirements. [6][7][8][84][85][86] Blood transfusions are related to the development of circulating antibodies which in turn lead to sensitization 18 and increased waiting times on heart transplant lists and increased risk of cellular rejection after transplantation. 18,87 Screening for acquired vWF deficiency could be performed and antiplatelet therapy should be individually tailored using point-of-care devices.…”

Section: Resultsmentioning

confidence: 99%

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

Petričević

Miličić

Boban

et al. 2015

Thorac cardiovasc Surg

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Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.

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