Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations

Moulton, Michael J.; Creswell, Lawrence L.; Mackey, Mary E.; Cox, James L.; Rosenbloom, Michael

doi:10.1016/s0022-5223(96)70380-x

Cited by 380 publications

(280 citation statements)

References 14 publications

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“…Surgical intervention for hemostasis is necessary in those patients with acute or persistent bleeding that can not be explained by coagulation disorders and that does not answer to the correction of specific factors. In our series, 3.7% of the patients needed surgical intervention for hemostasis, a result similar to the prevalence reported by other studies [1,2]. In a little less than half of the patients [1] the source of bleeding was not found and so a coagulopathy was usually stated as the principal cause.…”

Section: Commentssupporting

confidence: 89%

“…In our series, 3.7% of the patients needed surgical intervention for hemostasis, a result similar to the prevalence reported by other studies [1,2]. In a little less than half of the patients [1] the source of bleeding was not found and so a coagulopathy was usually stated as the principal cause. The clinical repercussions of surgical intervention for hemostasis are important [1], as it increases by three-fold AAS (20) Dicumarin (1.7) Heparin (14.5)…”

Section: Commentssupporting

confidence: 89%

“…As well as the higher hospital costs, blood and blood component transfusions and surgical re-interventions for hemostasis complications incurred, there are significant increases in the morbidity and mortality [1,2]. Thus, knowledge of risk factors for bleeding [3] is primordial to adopt preventive and therapeutic measures.…”

Section: Introductionmentioning

confidence: 99%

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Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To determine predictors of postoperative bleeding after cardiac surgery, in order to focus on preventive measures for high-risk populations.Methods: From October 2001 to March 2002, 411 consecutive adult cardiac surgery patients were prospectively studied, with the exception of those submitted to heart transplantation. In order to determine risk factors for postoperative bleeding, 20 preoperative, 17 operative and 6 postoperative variables were analyzed using univariate methods and multiple linear regression.Results: Operative procedures included coronary artery bypass grafting in 227 (55.2%) patients, valvar operations in 198 (48.2%), aortic surgery in 25 (6.1%) and combined procedures in 60 (14.6%). Cardiopulmonary bypass was used in 335 (81.5%) patients and anti-fibrinolysis agents in 148 (36%). The thirty-day mortality rate was 5.6% (23 patients). Mean 24-hour postoperative blood loss was 610 ± 500 mL (range 10-4900). Re-exploration for bleeding was required in 15 (3.7%) patients. Independent predictors of postoperative bleeding were emergency operations (p=0.049), postoperative metabolic acidosis (p=0.001), preoperative thrombocytopenia (p=0.034) and prolonged cardiopulmonary bypass (p=0.021).Conclusions: When possible, preoperative stabilization and correction of coagulation disturbances should be achieved in patients requiring urgent or emergent surgery and in those with thrombocytopenia. The duration of cardiopulmonary bypass should be minimized as long as this is practical. Postoperative metabolic acidosis must be actively corrected, especially the main determining causes. Descriptors

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Section: Commentssupporting

confidence: 89%

Section: Commentssupporting

confidence: 89%

See 1 more Smart Citation

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

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“…Several studies suggest cardiac surgical patients are at an increased risk of adverse outcomes, transfusion and hemorrhagic complications when receiving CLO preoperatively [1,2]. Cardiac surgery patients who experience significant postoperative bleeding or receive blood transfusions are at increased risk for other adverse outcomes [3,4]. Blood transfusions have been associated with increased rates of clinically significant infections, ischemic events, and 30-day mortality [5].…”

Section: Introductionmentioning

confidence: 99%

Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery

Petričević

Biočina

Miličić

et al. 2012

J Thromb Thrombolysis

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“…There is also evidence that excessive blood loss, rather than simply being a marker for surgical misadventure as it is often presumed, is independently associated with both morbidity and mortality. [1][2][3][4] Excessive blood loss after cardiac surgery can be due to incomplete surgical hemostasis, coagulopathy, or most often, a combination of the two. Along with surgical re-exploration to correct or rule out incomplete surgical hemostasis, management of patients with excessive blood loss is essentially supportive, being limited to blood component therapy to replenish RBCs, platelets, and coagulation factors.…”

mentioning

confidence: 99%

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference

Karkouti

Beattie

Crowther

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Recombinant activated factor VII (rFVIIa) is currently not approved by Health Canada or the Food and Drug Administration for treating excessive blood loss in nonhemophiliac patients undergoing on-pump cardiac surgery, but is increasingly being used "off-label" for this indication. A Canadian Consensus Conference was convened to generate recommendations for rFVIIa use in on-pump cardiac surgery. Methods: The panel undertook a literature review of the use of rFVIIa in both cardiac and non-cardiac surgery. Appropriateness, timing, and dosage considerations were addressed for three cardiac surgery indications: prophylactic, routine, and rescue uses. Recommendations were based on evidence from the literature and derived by consensus following recognized grading procedures. Results: The panel recommended against prophylactic or routine use of rFVIIa, as there is no evidence at this time that the benefits of rFVIIa outweigh its potential risks compared with standard hemostatic therapies. On the other hand, the panel made a weak recommendation (grade 2C) for the use of rFVIIa (one to two doses of 35-70 µg·kg -1 ) as rescue therapy for blood loss that is refractory to standard hemostatic therapies, despite the lack of randomized controlled trial data for this indication. Conclusions: In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients. Methodologically rigorous studies are needed to clarify its riskbenefit profile in cardiac surgery patients. 200 Elizabeth Street, Toronto, Ontario M5G 2C4,; E-mail: keyvan.karkouti@uhn.on.ca Disclosure statement: Novo Nordisk (Mississauga, Ontario, Canada), the makers of rFVIIa, funded this project through an unrestricted educational grant. Novo Nordisk was not involved in the selection of the members of the consensus panel, nor were they involved in the panel's review process, deliberations, conclusions, or manuscript preparation. The panel's chair selected the panel members, with the objective of achieving relevant multi-disciplinary expertise (i.e., anesthesiology, cardiac surgery, hematology, intensive care, and clinical epidemiology). The manuscript was primarily written by the panel chair (Keyvan Karkouti) and was approved by all of the panel members. All of the authors received an honorarium for attending the consensus conference.

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Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations

Abstract: These data indicate that meticulous attention to surgical hemostasis and possibly application of recently developed modalities designed to facilitate perioperative correction of coagulopathy could improve outcomes after cardiac operations.

Cited by 380 publications

References 14 publications

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference

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