Cardiac bypass haemostasis: putting blood through the mill

Bevan, David

doi:10.1046/j.1365-2141.1999.01182.x

Cited by 101 publications

(70 citation statements)

References 150 publications

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“…Consumption of coagulation factors has been well described in cardiac surgery, 30,46,47 as has the dilution of factors resulting from red cell transfusion and volume expanders. In addition, altered blood flow during CPB might have resulted in decreased synthetic function of coagulation factors by the liver.…”

Section: Discussionmentioning

confidence: 99%

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Taneja

Marwaha

Sinha

et al. 2009

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Taneja

Marwaha

Sinha

et al. 2009

Can J Anesth/J Can Anesth

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“…Excess bleeding was defined as >1000 mL within the initial 24 h for two reasons. This volume of blood loss has been previously used as a definition of excessive bleeding after CPB, 17,18 and additionally 1000 mL represents the 75th percentile of the patient population in this study. AUCs of ROTEM parameters were compared with the highest AUC of the routine laboratory parameters, to evaluate whether the difference in AUC was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

The association between rotational thromboelastometry parameters and blood loss after cardiac surgery with cardiopulmonary bypass

Bosch

Weerwind

Cate

et al. 2015

Cardiovascular and Thoracic Open

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Background: The objectives of this study were to investigate the changes in routine laboratory tests and rotational thromboelastometry variables after cardiopulmonary bypass and to investigate the association of these variables with postoperative blood loss. Methods: Blood was obtained at baseline, at admission to the intensive care unit, and at the first postoperative day. Rotational thromboelastometry tests and measurements of haemoglobin, haematocrit, platelet count, and plasma fibrinogen level (Clauss method) were performed. Excessive bleeding was defined as >1000 mL of chest tube drainage after surgery within 24 h. Results: After cardiopulmonary bypass, haemotocrit was decreased by 21%. Platelet count and fibrinogen level decreased more (35% and 42%, respectively). The largest change was found for clot formation time of INTEM (intrinsically activated coagulation) (+73%). Platelet count was not reflected by maximal clot firmness of PLATEM (platelet component specific coagulation). The decreases in FIBTEM (fibrinogen specific coagulation) maximum clot firmness and fibrinogen at the intensive care unit admission were comparable. Test results outside the reference range were associated with higher median blood loss when compared to values within the reference range, with most significant association for fibrinogen (p < 0.001) and FIBTEM maximal clot firmness (p = 0.016). At baseline, the ability of rotational thromboelastometry parameters to predict postoperative blood loss >1000 mL is higher than the predictive value of fibrinogen (area under the curve = 0.642; 95% confidence interval: 0.487-0.796), but only areas under the curve of APTEM (extrinsically activated coagulation with exclusion of fibrinolysis component) were significantly higher (p⩽0.05). At intensive care unit admission, the highest area under the curve was 0.689 (95% confidence interval: 0.549-0.828) for FIBTEM maximum clot firmness. Conclusion: Rotational thromboelastometry could be a useful point-of-care method to monitor haemostasis because it is a faster and more informative method, and it has a slightly higher predictive ability for blood loss compared to fibrinogen.

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“…14,15 The pathophysiology of post bypass bleeding, particularly in complex cardiac surgery, is incompletely understood, but appears to be multifactorial, with platelet dysfunction and decreased fibrinogen concentrations playing important roles. [15][16][17] Australian transfusion guidelines 14 suggest that cryoprecipitate may be indicated when bleeding is associated with decreased fibrinogen, and that fresh frozen plasma may be indicated for bleeding after cardiac surgery. Our guideline recommends platelet and cryoprecipitate transfusion in response to decreases in platelets and fibrinogen concentrations in lieu of using fresh frozen plasma alone.…”

Section: Discussionmentioning

confidence: 99%

Audit of factor VIIa for bleeding resistant to conventional therapy following complex cardiac surgery

McCall

Story

Karapillai

2006

Can J Anesth/J Can Anesth

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Purpose:There are an increasing number of anecdotal reports and trials of recombinant activated factor VII (rFVIIa) for bleeding during surgery. The reports of rFVIIa during cardiac surgery are limited. We report our experience using rFVIIa, in the operating room; to treat bleeding that prevented chest closure, despite appropriate conventional treatment, following complex cardiac surgery.Methods: Retrospective chart review, at an Australian University hospital and associated private hospital, of cardiac surgery patients given rFVIIa (usual dose 90 μg·kg -1 ). We used rFVIIa for bleeding that prevented closure of the chest despite administration of blood products, protamine, and surgical attempts to secure hemostasis.Results: Recombinant activated factor VII was administered on 55 occasions to 53 patients. Most patients had complex aortic or valve surgery. Median bypass time was 266 min. Before administering rFVIIa, patients received (median): packed red cells four units; platelets 15 units; fresh frozen plasma eight units; and cryoprecipitate ten units. After administering rFVIIa the median doses of donor blood products up to 12 hr after intensive care unit admission were: packed red cells one unit; platelets zero units; fresh frozen plasma zero units; and cryoprecipitate zero units. The decrease in doses of all blood products was significant (P < 0.001). We could not determine if rFVIIa played a role in significant mortality (19%) and morbidity (17%). Conclusion:Use of rFVIIa in cardiac surgery may be effective, but definitive clinical trials are needed to clarify its role in clinical practice and safety. We present an rFVIIa guideline developed during the audit period. Objectif

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Cardiac bypass haemostasis: putting blood through the mill

Cited by 101 publications

References 150 publications

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

The association between rotational thromboelastometry parameters and blood loss after cardiac surgery with cardiopulmonary bypass

Audit of factor VIIa for bleeding resistant to conventional therapy following complex cardiac surgery

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