First-line Therapy with Coagulation Factor Concentrates Combined with Point-of-Care Coagulation Testing Is Associated with Decreased Allogeneic Blood Transfusion in Cardiovascular Surgery

Görlinger, Klaus; Dirkmann, Daniel; Hanke, Alexander; Kamler, Markus; Kottenberg, Eva; Thielmann, Matthias; Jakob, Heinz; Peters, Jürgen

doi:10.1097/aln.0b013e31823497dd

Cited by 399 publications

(316 citation statements)

References 63 publications

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“…The main confounding factors for bleeding include coagulation abnormalities depending on the type of preexisting liver disease and hyperfibrinolysis, particularly after reperfusion [6,7]. Advances in the understanding of the pathophysiology of coagulation and in the improvement of surgical skills, the introduction of specific techniques as well as point-of-care diagnostics and specific treatments have resulted in the significant reduction of blood loss [8,9]. However, in some patients with end-stage liver disease (ESLD) the risk to develop thrombosis is higher than to develop bleeding.…”

Section: Introductionmentioning

confidence: 99%

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Saner

Gieseler²,

Akız³

et al. 2013

Digestion

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Liver transplantation in cirrhotic patients is accompanied by severe bleeding. Indeed, the first 100 recipients of liver allografts transplanted by Thomas E. Starzl died mainly by uncontrolled bleeding. Since then, much progress has been made as to the understanding of the pathophysiology and the treatment of hemostatic disorders in cirrhotic patients. The aim of this review is to provide a state-of-the-art overview on recent developments and treatment options for hemostatic disorder in cirrhotic patients. Patients with end-stage-liver disease (ESLD) do not suffer only from procoagulant deficiency; there is also a lack of natural anticoagulants (i.e. proteins C and S) and profibrinolytics. Conventional laboratory methods such as the determination of the international normalized ratio or the activated partial thromboplastin time cannot predict bleeding complications in these patients. Progressive diagnostic techniques reveal that cirrhotic patients have the same capacity to produce thrombin like healthy volunteers. Moreover, cirrhotic patients - and particularly those with primary biliary cirrhosis or primary sclerosing cholangitis - are at a higher risk for developing thrombosis as compared with healthy controls. Hemostatic alterations are common in cirrhotic patients; they involve both the pro- and the anticoagulant pathways. However, this is a very delicate balance, which may be shifted to either of these pathways by different treatments thereby causing bleeding or thrombosis, respectively.

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Section: Introductionmentioning

confidence: 99%

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Saner

Gieseler²,

Akız³

et al. 2013

Digestion

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“…A retrospective analysis of 3865 patients undergoing cardiovascular surgery demonstrated that the incidence of thromboembolic events is reduced through POC-based administration of coagulation factor concentrates [6]. The Guidelines of the Societies of Thoracic Surgeons and Cardiovascular Anesthesiologists have included the use of POC devices in their blood conservation guidelines to guide transfusion therapies [7].…”

Section: Introductionmentioning

confidence: 99%

Point of care coagulation testing in neurosurgery

Beynon

Unterberg

Sakowitz

2015

Journal of Clinical Neuroscience

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“…Thromboelastometry has already widely been used to monitor coagulation changes and to guide coagulation therapy in trauma patients [35,36,37,43,44,45,52,53,54], during liver transplantation [4,16,23,25,38,41,42,43,44,45,47,55,56], and during cardiac surgery [24,25,39,43,44,45,57,58,59,60,61]. …”

Section: Methodsmentioning

confidence: 99%

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

Fayed

Mourad

Yassen

et al. 2015

Transfus Med Hemother

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Background: The ability to predict transfusion requirements may improve perioperative bleeding management as an integral part of a patient blood management program. Therefore, the aim of our study was to evaluate preoperative thromboelastometry as a predictor of transfusion requirements for adult living donor liver transplant recipients. Methods: The correlation between preoperative thromboelastometry variables in 100 adult living donor liver transplant recipients and intraoperative blood transfusion requirements was examined by univariate and multivariate linear regression analysis. Thresholds of thromboelastometric parameters for prediction of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate transfusion requirements were determined with receiver operating characteristics analysis. The attending anesthetists were blinded to the preoperative thromboelastometric analysis. However, a thromboelastometry-guided transfusion algorithm with predefined trigger values was used intraoperatively. The transfusion triggers in this algorithm did not change during the study period. Results: Univariate analysis confirmed significant correlations between PRBCs, FFP, platelets or cryoprecipitate transfusion requirements and most thromboelastometric variables. Backward stepwise logistic regression indicated that EXTEM coagulation time (CT), maximum clot firmness (MCF) and INTEM CT, clot formation time (CFT) and MCF are independent predictors for PRBC transfusion. EXTEM CT, CFT and FIBTEM MCF are independent predictors for FFP transfusion. Only EXTEM and INTEM MCF were independent predictors of platelet transfusion. EXTEM CFT and MCF, INTEM CT, CFT and MCF as well as FIBTEM MCF are independent predictors for cryoprecipitate transfusion. Thromboelastometry-based regression equation accounted for 63% of PRBC, 83% of FFP, 61% of cryoprecipitate, and 44% of platelet transfusion requirements. Conclusion: Preoperative thromboelastometric analysis is helpful to predict transfusion requirements in adult living donor liver transplant recipients. This may allow for better preparation and less cross-matching prior to surgery. The findings of our study need to be re-validated in a second prospective patient population.

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First-line Therapy with Coagulation Factor Concentrates Combined with Point-of-Care Coagulation Testing Is Associated with Decreased Allogeneic Blood Transfusion in Cardiovascular Surgery

Abstract: First-line administration of coagulation factor concentrates combined with point-of-care testing was associated with decreased incidence of blood transfusion and thrombotic/thromboembolic events.

Cited by 399 publications

References 63 publications

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation

Point of care coagulation testing in neurosurgery

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

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