Therapeutic options for perioperatively acquired platelet dysfunctions

Weber, Christian Friedrich; Schneider, Angelina; Kirschning, Thomas; Hofstetter, Christian; Zacharowski, Kai; Görlinger, Klaus

doi:10.1007/s00101-009-1599-8

Cited by 15 publications

(2 citation statements)

References 73 publications

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“…3 Randomized trials have proven that point-of-care (POC)-based hemotherapy results in less blood loss and a lower transfusion rate than treatments based on the results of conventional laboratory analyses. 4–10…”

Section: Introductionmentioning

confidence: 99%

Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

Raspé

Besch

Charitos

et al. 2018

Clin Appl Thromb Hemost

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We aimed to detect alterations and deficits in hemostasis during cardiac surgery with cardiopulmonary bypass (CPB) using point-of-care-supported coagulation analysis (rotational thromboelastometry, impedance aggregometry), in addition to single factor assays for the measurement of fibrinogen (FI) and factor XIII (FXIII) levels. Forty-one patients scheduled for elective cardiac surgery with CPB were enrolled in this observational study. Perioperative measurement (pre-, postheparin, 30-minutes before the end of bypass, 1-hourpostoperatively) of standard laboratory variables, additional rotational thromboelastometry (ROTEM; International GmbH, Munich, Germany), Multiplate analysis (Roche, Switzerland), and an assay of FXIII activity were performed as well as the collection of epidemiological data and blood loss. The FI and FXIII levels as well as the measured ROTEM and Multiplate parameters correlated weakly with the blood loss. Clotting time and maximum clot firmness (MCF) of the intrinsically activated ROTEM showed a good correlation ( r = 0.378; P < .05, r = 0.305; P < .05) with postoperative drainage loss, suggesting a dependence of blood loss on the initial intrinsic activity. Additionally, perioperative FI or FIBTEM levels and the FXIII levels correlated with each other. Intrinsically activated ROTEM showed a good correlation with postoperative drainage loss, thus suggesting a dependence of blood loss on the initial intrinsic activity and therefore facilitating clinicians to assess postoperative bleeding complications. Based on the FI level or the MCF measured by ROTEM, it may also be possible to assess the FXIII concentration. Especially in chronically ill and massive bleeding cardiac surgery patients with significantly decreased FXIII levels, the knowledge of FXIII deficiency may help clinicians to treat coagulation disorders more adequately.

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Section: Introductionmentioning

confidence: 99%

Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

Raspé

Besch

Charitos

et al. 2018

Clin Appl Thromb Hemost

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“…In principle, plasma fibrinogen concentrations above 2.5 g/l cannot be achieved by FFP transfusion. Furthermore, the evidence is growing that, apart from haemostatic drugs such as DDAVP, tranexamic acid and rFVIIa, high fibrinogen plasma concentrations can compensate for low platelet counts or platelet dysfunction [65][66][67][68][69][70][71][72]. However, high amounts of fibrinogen concentrate have to be administered in order to increase the MCF in FibTEM to the high normal values of 18-25 mm that seem to be necessary to achieve this goal, and further studies are required to prove this concept [21,55,60,61,68,71,73].…”

Section: Formula-driven Transfusion Algorithmsmentioning

confidence: 99%

Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy

Görlinger

Fries²,

Dirkmann³

et al. 2012

Transfus Med Hemother

193

107

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Background: Massive bleeding and transfusion of packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets are associated with increased morbidity, mortality and costs. Patients and Methods: We analysed the transfusion requirements after implementation of point-of-care (POC) coagulation management algorithms based on early, calculated, goal-directed therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in different perioperative settings (trauma surgery, visceral and transplant surgery (VTS), cardiovascular surgery (CVS) and general and surgical intensive care medicine) at 3 different hospitals (AUVA Trauma Centre Salzburg, University Hospital Innsbruck and University Hospital Essen) in 2 different countries (Austria and Germany). Results: In all institutions, the implementation of POC coagulation management algorithms was associated with a reduction in the transfusion requirements for FFP by about 90% (Salzburg 94%, Innsbruck 88% and Essen 93%). Furthermore, PRBC transfusion was reduced by 8.4–62%. The incidence of intraoperative massive transfusion (≧10 U PRBC) could be more than halved in VTS and CVS (2.56 vs. 0.88%; p < 0.0001 and 2.50 vs. 1.06%; p = 0.0007, respectively). Platelet transfusion could be reduced by 21–72%, except in CVS where it increased by 115% due to a 5-fold increase in patients with dual antiplatelet therapy (2.7 vs. 13.7%; p < 0.0001). Conclusions: The implementation of perioperative POC coagulation management algorithms based on early, calculated, goaldirected therapy with fibrinogen concentrate and PCC is associated with a reduction in the transfusion requirements for FFP, PRBC and platelets as well as with a reduced incidence of massive transfusion. Thus, the limited blood resources can be used more efficiently.

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Protective Effects of Tranexamic Acid on Clopidogrel Before Coronary Artery Bypass Grafting

Shi¹,

Ji²,

Ren³

et al. 2013

JAMA Surg

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Therapeutic options for perioperatively acquired platelet dysfunctions

Cited by 15 publications

References 73 publications

Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy

Protective Effects of Tranexamic Acid on Clopidogrel Before Coronary Artery Bypass Grafting

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