The effect of warm heart surgery on postoperative bleeding

Yau, Terrence M.; Carson, Susan; Weisel, Richard D.; Ivanov, Joan; Sun, Zhao; Yu, Rebecca; Glynn, Michael; Teasdale, Sallie J.

doi:10.1016/s0022-5223(19)34881-0

Cited by 79 publications

(27 citation statements)

References 12 publications

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“…19 Finally, in another comparison study between TA and EACA, both antifibrinolytic agents were shown to reduce postoperative blood loss, but only TA administration resulted in a lower frequency of red blood cell transfusions. 25 The present prospective randomized study agrees with other prior comparison studies, suggesting that TA may be a more efficacious choice for prophylactic treatment of fibrinolysis and blood loss following cardiac surgery requiring CPB.…”

Section: Discussionsupporting

confidence: 90%

Tranexamic Acid Reduces Bleeding After Cardiopulmonary Bypass When Compared to Epsilon Aminocaproic Acid and Placebo

et al. 1997

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Section: Discussionsupporting

confidence: 90%

Tranexamic Acid Reduces Bleeding After Cardiopulmonary Bypass When Compared to Epsilon Aminocaproic Acid and Placebo

et al. 1997

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“…However, if their conclusions hold true, they might have major financial implications since EACA is mueh cheaper than high-dose Apt. Postoperative blood loss was reduced similarly by EACA, TA or warm perfusion in a study by Yau et al 9 In this latter study, requirements for HBP were marginally reduced by TA. Thus, a change in perfusion technique (normothermia vs hypothermia) eould obviate the need for any antifibrinolytic medication altogether.…”

Section: Epsilon-aminocaproic Acid (Amicar~)mentioning

confidence: 54%

“…14 Transfusion requirements did not differ among groups (TA 10 g vs 20 g vs control) due to the effectiveness of autotransfusion in preserving blood loss. ~4 As mentioned previously in a study of 146 patients by Yau et al, 9 only TA reduced the number of units of packed red blood cells administered to each patient (but not the frequency of platelet, plasma, or cryoprecipitate transfusion) from a mean of three to two units, while postoperative bleeding was reduced similarly by TA, EACA, or warm systemic perfusion (35-37~ 9 It is worth noting that, in these three studies, 9,13,14 postoperative bleeding after hypothermic perfusion (25-29~ ranged from 1000-1200 ml in the control groups.…”

Section: Epsilon-aminocaproic Acid (Amicar~)mentioning

confidence: 64%

Natural and synthetic antifibrinolytics in adult cardiac surgery: efficacy, effectiveness and efficiency

Hardy

Bélisle

1994

Can J Anaesth

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Epsilon-aminocaproic acid and tranexamic acid, two synthetic antifibrinolytics, and aprotinin, an antifibrinolytic derived from bovine lung, are used to reduce excessive bleeding and transfusion of homologous blood products (HBP) after cardiac surgery. This review analyzes the studies on the utilization of antifibrinolytics in adult cardiac surgery according to the epidemiological concepts of efficacy, effectiveness and efficiency. A majority of published studies confirm the efficacy of antifibrinolytics administered prophylactically to reduce postoperative bleeding and transfusion of HBP. More studies are needed, however, to compare antifibrinolytics and determine if any one is superior to the others. Despite their demonstrated efficacy, antifibrinolytics are only one of the options available to diminish the use of HBP. Other blood-saving techniques, surgical expertise, temperature during cardiopulmonary bypass and respect of established transfusion guidelines may modify the effectiveness of antifibrinolytics to the point where antifibrinolytics may not be necessary. At this time, insufficient data have been published to perform a cost vs benefit analysis of the use of antifibrinolytics. This complex analysis takes into account not only direct costs (cost of the drug and of blood products), but also the ensuing effects of treatment such as: length of stay in the operating room, in the intensive care unit and in the hospital; need for surgical re-exploration; treatment of transfusion or drug-related complications, etc. In particular, the risk of thrombotic complications associated with antifibrinolytics is the subject of an ongoing, unresolved controversy.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…A total of 6731 patients from 44 randomized controlled trials in 14 countries were identified and subject to meta‐analysis (Fig. 1) [12,13,15–63]. All studies were published in English.…”

Section: Resultsmentioning

confidence: 99%

Benefits and Risks of Maintaining Normothermia during Cardiopulmonary Bypass in Adult Cardiac Surgery: A Systematic Review

Tan

2009

Cardiovascular Therapeutics

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Cardiopulmonary bypass is associated with significant morbidities, and the ideal temperature management during cardiopulmonary bypass remains uncertain. This review assessed the benefits and risks of maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery. A total of 6731 patients from 44 randomized controlled trials in 14 countries, comparing normothermic (>34• C) and hypothermic (≤34 Hypothermic bypass was, however, associated with an increased risk of allogeneic red blood cells (RR 1.19, 95% CI 1.07-1.34, I 2 = 0%, P = 0.002), fresh frozen plasma (RR 1.54, 95% CI 1.06-2.24, I 2 = 7.7%, P = 0.02), and platelet transfusion (RR 2.53, 95% CI 1.26-5.06, I 2 = 44%, P = 0.009). The risk of stroke, cognitive decline, atrial fibrillation, use of inotropic support or intra-aortic balloon pump, myocardial infarction, all-cause infections, and acute kidney injury after cardiac surgery was not significantly different between the two groups. The differences in the bypass time and targeted perfusion temperature were not significantly related to the risk of mortality and stroke. The current evidence suggests that maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery is as safe as that of hypothermic surgery, and associated with a reduced risk of allogeneic blood transfusion. Review methodRandomized controlled trials comparing normothermic (>34• C) and hypothermic (≤34 Take home messageThe current evidence suggests that maintaining hypothermia during cardiopulmonary bypass in adult cardiac surgery is associated with an increased risk of 260

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The effect of warm heart surgery on postoperative bleeding

Cited by 79 publications

References 12 publications

Tranexamic Acid Reduces Bleeding After Cardiopulmonary Bypass When Compared to Epsilon Aminocaproic Acid and Placebo

Tranexamic Acid Reduces Bleeding After Cardiopulmonary Bypass When Compared to Epsilon Aminocaproic Acid and Placebo

Natural and synthetic antifibrinolytics in adult cardiac surgery: efficacy, effectiveness and efficiency

Benefits and Risks of Maintaining Normothermia during Cardiopulmonary Bypass in Adult Cardiac Surgery: A Systematic Review

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