Patient blood management and patient safety

Zacharowski, Kai; Zoller, Heinz; Steinbicker, Andrea U.

doi:10.1097/aco.0000000000001196

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…Patient blood management strategies, which encompass optimization of erythropoiesis, reduce periprocedural bleeding, and optimize patient’s tolerance of anemia, are endorsed by the World Health Organization (Desai et al 2018 ; Maryuningsih et al 2023 ; Zacharowski et al 2022 ). Desmopressin is one of several strategies to mitigate the risk of periprocedural bleeding.…”

Section: Discussionmentioning

confidence: 99%

Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis

Wang,

Lebedeva,

Yang

et al. 2024

Perioper Med

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We systematically reviewed the literature to investigate the effects of peri-procedural desmopressin in patients without known inherited bleeding disorders undergoing surgery or other invasive procedures. We included 63 randomized trials (4163 participants) published up to February 1, 2023. Seven trials were published after a 2017 Cochrane systematic review on this topic. There were 38 trials in cardiac surgery, 22 in noncardiac surgery, and 3 in non-surgical procedures. Meta-analyses demonstrated that desmopressin likely does not reduce the risk of receiving a red blood cell transfusion (25 trials, risk ratio [RR] 0.95, 95% confidence interval [CI] 0.86 to 1.05) and may not reduce the risk of reoperation due to bleeding (22 trials, RR 0.75, 95% CI 0.47 to 1.19) when compared to placebo or usual care. However, we demonstrated significant reductions in number of units of red blood cells transfused (25 trials, mean difference -0.55 units, 95% CI − 0.94 to − 0.15), total volume of blood loss (33 trials, standardized mean difference − 0.40 standard deviations; 95% CI − 0.56 to − 0.23), and the risk of bleeding events (2 trials, RR 0.45, 95% CI 0.24 to 0.84). The certainty of evidence of these findings was generally low. Desmopressin increased the risk of clinically significant hypotension that required intervention (19 trials, RR 2.15, 95% CI 1.36 to 3.41). Limited evidence suggests that tranexamic acid is more effective than desmopressin in reducing transfusion risk (3 trials, RR 2.38 favoring tranexamic acid, 95% CI 1.06 to 5.39) and total volume of blood loss (3 trials, mean difference 391.7 mL favoring tranexamic acid, 95% CI − 93.3 to 876.7 mL). No trials directly informed the safety and hemostatic efficacy of desmopressin in advanced kidney disease. In conclusion, desmopressin likely reduces periprocedural blood loss and the number of units of blood transfused in small trials with methodologic limitations. However, the risk of hypotension needs to be mitigated. Large trials should evaluate desmopressin alongside tranexamic acid and enroll patients with advanced kidney disease.

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Section: Discussionmentioning

confidence: 99%

Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis

Wang,

Lebedeva,

Yang

et al. 2024

Perioper Med

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“…A 2021 World Health Organization (WHO) statement advocates for blood management programs to enhance patient safety by promoting consideration of anticoagulation therapy, anemia management, and autologous transfusion [66]. As these programs continue to develop, so does the body of evidence supporting intraoperative blood management with both allogenic and autologous (preplanned donation and cell-salvage) transfusion for treatment of procedural blood loss [67]. Cell salvage is already widely used in cardiac, orthopedics, and trauma disciplines [67].…”

Section: Whole Blood Beyond the Trauma Baymentioning

confidence: 99%

“…As these programs continue to develop, so does the body of evidence supporting intraoperative blood management with both allogenic and autologous (preplanned donation and cell-salvage) transfusion for treatment of procedural blood loss [67]. Cell salvage is already widely used in cardiac, orthopedics, and trauma disciplines [67]. Newer data supporting the use of intra-operative cell salvage with leukocyte reduction filters addresses concerns regarding immunogenic response and contamination.…”

Section: Whole Blood Beyond the Trauma Baymentioning

confidence: 99%

What's new in whole blood resuscitation? In the trauma bay and beyond

Coulthard,

Kaplan,

Cannon

2024

Current Opinion in Critical Care

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Purpose of review Transfusion therapy commonly supports patient care during life-threatening injury and critical illness. Herein we examine the recent resurgence of whole blood (WB) resuscitation for patients in hemorrhagic shock following trauma and other causes of severe bleeding. Recent findings A growing body of literature supports the use of various forms of WB for hemostatic resuscitation in military and civilian trauma practice. Different types of WB include warm fresh whole blood (FWB) principally used in the military and low titer O cold stored whole blood (LTOWB) used in a variety of military and civilian settings. Incorporating WB initial resuscitation alongside subsequent component therapy reduces aggregate blood product utilization and improves early mortality without adversely impacting intensive care unit length of stay or infection rate. Applications outside the trauma bay include prehospital WB and use in patients with nontraumatic hemorrhagic shock. Summary Whole blood may be transfused as FWB or LTOWB to support a hemostatic approach to hemorrhagic shock management. Although the bulk of WB resuscitation literature has appropriately focused on hemorrhagic shock following injury, extension to other etiologies of severe hemorrhage will benefit from focused inquiry to address cost, efficacy, approach, and patient-centered outcomes.

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