The stratification of cardiac surgical procedures according to use of blood products: a retrospective analysis of 1480 cases

Hardy, Jean‐François; Perrault, Jean; Tremblay, Normand; Robitaille, Danielle; Blain, Robert; Carrier, Michel

doi:10.1007/bf03007591

Cited by 85 publications

(36 citation statements)

References 19 publications

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“…Our study has some apparent limitations. First, it has been shown that coagulation profile laboratory tests including bleeding time, PT, APTT, fibrinogen, fibrin split products, platelet count, and mean platelet volume could reliably predict MVB after CPB 11,20 . Although both groups had the same number of draws at the same time points in our study, it was possible that the TEG group might have been better equipped to treat coagulation defects than the CDT group.…”

Section: Discussionmentioning

confidence: 84%

“…Currently, routine use of transfusion algorithms has not been extensively accepted in cardiac surgical practice, and their application is mostly reserved for patients undergoing high‐risk surgical procedures for bleeding 7,8 . However, it is now well known that even patients undergoing elective routine coronary artery bypass grafting (CABG) consume a considerable amount of blood and blood products 11 . In this prospective study, we hypothesized that simple and routinely used kaolin‐activated TEG (kTEG)‐based transfusion algorithm would decrease the need for allogeneic blood exposure and blood loss in patients undergoing conventional CABG.…”

mentioning

confidence: 99%

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Thromboelastography-Based Transfusion Algorithm Reduces Blood Product Use after Elective CABG: A Prospective Randomized Study

Isbir

Tetik

et al. 2009

Journal of Cardiac Surgery

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Section: Discussionmentioning

confidence: 84%

mentioning

confidence: 99%

Thromboelastography-Based Transfusion Algorithm Reduces Blood Product Use after Elective CABG: A Prospective Randomized Study

Isbir

Tetik

et al. 2009

Journal of Cardiac Surgery

191

180

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“…A recent study of 1480 cases at the Montreal Heart Institute attempted to stratify cardiac surgical procedures according to use of blood products. 79 This retrospective report on the transfusion of blood products in adult cardiac surgery using CPB indicated that primary and repeat combined procedures (a combination of myocardial revascularization and valvular surgery), and repeat valve surgery were associated with the greatest exposure to foreign blood products, patients being exposed to 10, 13 and 10 units of any blood product respectively. Reoperations for myocardial revascularization were associated with an intermediate consumption of blood products (exposure to eight units of homologous blood products).…”

Section: Patients Most At Risk Of Being Transfusedmentioning

confidence: 98%

Natural and synthetic antifibrinolytics in cardiac surgery

1992

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In an effort to reduce morbidity associated with transfusion of blood products, the use of antifibrinolytics to decrease bleeding and transfusions after cardiopulmonary bypass ( CPB) is receiving widespread attention. The predominant haemostatic defect induced by CPB and, therefore Afin de rdduire morbiditd associde aux transfusion sanguines, les anesthdsistes et les chirurgiens cardiaques utilisent de plus en plus les antifibrinolytiques darts le but de diminuer le saignement et les besoins transfusionnels secondaires it la circulation extracorporelle ( CEC). Les modifications de l 'hdmostase induites

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“…Prospective, randomized trials of TEG‐based transfusion algorithms have been demonstrated to reduce blood product use in a number of studies including patients undergoing cardiac surgery 2 or elective coronary artery bypass surgery and in aortic surgery with circulatory arrest 25,26 . In an early, pivotal study, adult patients who underwent cardiac surgical procedures that had moderate to high risk for requiring transfusion 27 were studied, including valve replacements, coronary artery bypass surgery, or combined procedures 2 . Patients were randomly assigned to receive either algorithm‐based transfusion therapy (Fig.…”

Section: Poct: Clinical Studiesmentioning

confidence: 99%

Use of point‐of‐care testing for plasma therapy

Goodnough

Hill

2012

Transfusion

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Use of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a tool for decisions for transfusions of blood components. Clinical settings such as liver transplantation, cardiothoracic surgery, and trauma are particularly in need of such diagnostic tests because of the complex coagulopathies that can develop in these settings of substantial hemorrhage and need for blood component support. Successful implementation of POCT requires collaboration between surgery, anesthesia, critical care, and the laboratory to ensure proper quality control of equipment, operator training and competency, medical records test results, billing procedures, and consensus-derived transfusion algorithms for cost-effective, targeted blood component transfusion support. In this review we summarize clinical evidence for the effectiveness of POCT, along with some future directions for this strategy.U se of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a decision-guiding tool for blood component therapy, particularly in patients with substantial hemorrhage or complex coagulopathy. Thromboelastography (TEG) was first developed in 1948 and is a global assay of coagulation that uses whole blood to produce a tracing that records kinetic changes in clot formation. This tracing allows the rapid assessment of coagulation and fibrinolysis that is dependent on the interaction of the coagulation factors, platelets (PLTs), and fibrinogen.1 It has been tested and is now widely used in various clinical scenarios such as cardiac surgery, 2 hepatic transplantation, 3 and major trauma (with concomitant massive transfusion therapy) 4 to monitor and guide blood component therapy. Newer POCT technologies have also become available that provide rapid hemostasis results with whole blood. The accuracy and reliability of the POCT for prothrombin time (PT), activated partial thromboplastin time (aPTT), and PLT assays have been demonstrated. 5,6 POCT systems are being developed to impact use of blood component therapy utilizing two variables: timely availability of assay results and their link to algorithms for result-based use of blood component therapy. 2,7,8 This review will summarize the use of these strategies as currently applied, along with potential future applications. COAGULOPATHY IN SURGICAL SETTINGSThe complex coagulopathy in patients undergoing liver transplant, along with the role of point-of-care monitoring in this setting, have been well established 3 and will therefore not be discussed further in this review. Cardiopulmonary bypassExposure of blood to an extracorporeal circuit results in abnormalities of the hemostatic system, which can lead to excessive bleeding; 9 the type of cardiac procedure and the duration of cardiopulmonary bypass (CPB) influence the risk for development of coagulopathic bleeding, 10 and the volumes of cardiac surgery procedures along with substantial number of blood components transfused in these patients, have made this clinical setting an impo...

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The stratification of cardiac surgical procedures according to use of blood products: a retrospective analysis of 1480 cases

Cited by 85 publications

References 19 publications

Thromboelastography-Based Transfusion Algorithm Reduces Blood Product Use after Elective CABG: A Prospective Randomized Study

Thromboelastography-Based Transfusion Algorithm Reduces Blood Product Use after Elective CABG: A Prospective Randomized Study

Natural and synthetic antifibrinolytics in cardiac surgery

Use of point‐of‐care testing for plasma therapy

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