The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding

Vuylsteke, Alain; Pagel, Christina; Gerrard, Caroline; Reddy, Brian P.; Nashef, Samer A.M.; Aldam, Poppy; Utley, Martin

doi:10.1016/j.ejcts.2010.10.003

Cited by 134 publications

(91 citation statements)

References 23 publications

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“…However, before the risk stratification model can be used clinically, it needs to be prospectively validated. Specifically, additional confirmatory studies are required to ensure that the prevalence reported by our model is accurate ("calibration") and that our stratification schema can reliably discern css at low and high risk of cvd ("discrimination") 23 . Similar attempts to design a prediction algorithm akin to our simple risk stratification schema have been made in the past.…”

Section: Discussionmentioning

confidence: 99%

Predicting the Risk of Cardiovascular Comorbidities in Adult Cancer Survivors

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Predicting the Risk of Cardiovascular Comorbidities in Adult Cancer Survivors

et al. 2013

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“…These identify age, female sex, low body mass index (BMI), preoperative anaemia, chronic kidney disease, poor left ventricular function and recent myocardial ischaemia as predictive of excessive bleeding or MBT. 63,64 The mechanism by which these factors contribute to bleeding is poorly understood. Existing scores are not widely used because of the limited generalisability of risk models developed in single centres or subpopulations of patients.…”

Section: Preoperative Morbiditymentioning

confidence: 99%

“…In addition to standard care, current blood management guidelines recommend (class 1, level of evidence C 24 ) that patients undergo a formal assessment and documentation of bleeding risk. Risk scores that may accurately predict the risk of bleeding and red cell transfusion exist; 63,64,88,89 however, these are not widely used. The predictive accuracy of any new diagnostic test should therefore complement appropriate clinical assessment and the benefits of additional testing should be assessed beyond those attributable to clinical assessment combined with standard testing.…”

Section: Point-of-care Coagulation and Platelet Testing In Cardiac Sumentioning

confidence: 99%

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Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

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“…Recurrent factors associated with increased bleeding risk are underweight patients, re-do and complex procedures (e.g. multiple valve replacements or operations involving the aortic arch), as well as emergency operations [1,15,16].…”

Section: Causes Of Excessive Bleedingmentioning

confidence: 99%

Haemostatic management of cardiac surgical haemorrhage

2014

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SummaryAlmost 30 000 cardiopulmonary bypass operations are performed in the UK every year, consuming a considerable portion of the UK blood supply. Each year, in cardiac surgery, 90% of blood products are used by only 10% of patients, and over the past 25 years, much innovation and research has gone into improving peri-operative diagnosis and therapy for these patients. Visco-elastic tests performed at the bedside, with modifications to allow direct quantification of fibrinogen levels, are probably the biggest advancement. There is no clear advantage of thromboelastometry over thromboelastography, and the published literature remains scarce. Visco-elastic testing has recently been coupled with the systematic replacement of clotting factors by means of factor concentrates, with objective improvement in terms of blood loss, red blood cell usage and surgical re-exploration. The National Institute for Health and Care Excellence has reviewed the available evidence and recommended visco-elastic tests as cost effective in cardiac surgery. Factor concentrates, however, carry significant risks, particularly unnecessary donor exposures, potential selective over-correction of partial deficiencies and the possibility that the postoperative risk of venous thromboembolism is increased; as yet there are no data on risk-benefit analysis. There are a number of promising drugs used in topical haemostasis, but the requirement to apply these before major bleeding is manifest limits their use considerably. Hyperfibrinolysis is less important than in the past due to the wide spread adoption of antifibrinolytic agents and close intra-operative monitoring of heparin effect.

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The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding

Abstract: We have developed a simple risk stratification score that can separate, preoperatively, patients into risk groups with markedly different rates of severe postoperative bleeding.

Cited by 134 publications

References 23 publications

Predicting the Risk of Cardiovascular Comorbidities in Adult Cancer Survivors

Predicting the Risk of Cardiovascular Comorbidities in Adult Cancer Survivors

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Haemostatic management of cardiac surgical haemorrhage

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