Thresholds for Perioperative Administration of Hemostatic Blood Components and Coagulation Factor Concentrates: An Unmet Medical Need

Bolliger, Daniel; Mauermann, Eckhard; Tanaka, Kenichi A.

doi:10.1053/j.jvca.2015.02.023

Cited by 20 publications

(7 citation statements)

References 123 publications

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“…1 Despite that obvious bleeding sources from surgical lesions can be regularly identified in re-exploration, 15 medical coagulopathy might be a more common source of hemorrhage after cardiopulmonary bypass (CPB). The true incidence of coagulopathy after cardiac surgery is difficult to determine and might be highly variable depending on definition, 17 pre-existing coagulopathy, type of surgery, length of CPB, and surgical technique. Postoperative bleeding and coagulopathy have major impact on morbidity and mortality, 13 as they increase the transfusion of allogeneic blood products including PRBC, fresh frozen plasma and platelet concentrates, the rate of surgical re-exploration, thromboembolic events, intubation time, and length of stay on the intensive care unit (ICU).…”

Section: Coagulopathy After Cardiopulmonary Bypassmentioning

confidence: 99%

“…Disruption of platelet's procoagulant activity thus leads to decreased fibrinogen binding to platelet GPIIb/IIIa receptors, and/or low thrombin generation on less aggregated platelets. 59 A threshold of 50 Â 10 9 /L might, therefore, only be feasible in patients without preoperative intake of potent platelet inhibitors such as P2Y 12 receptor antagonists, 17 and platelets are often empirically given in patients under the influence of P2Y 12 inhibitors or undergoing complex cardiac surgery. 73 The use of platelet function testing has, therefore, been suggested in combination with thromboelastometry.…”

Section: Platelet Function Testingmentioning

confidence: 99%

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Point-of-Care Coagulation Testing in Cardiac Surgery

Bolliger

Tanaka

2017

Semin Thromb Hemost

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Bleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment decisions are time sensitive. Point-of-care (POC) testing has an advantage over standard laboratory tests for faster turn-around times, and timely decision on coagulation intervention(s). The most common POC coagulation testing is the activated clotting time (ACT), used to monitor heparin therapy while on cardiopulmonary bypass. Viscoelastic coagulation tests including thromboelastometry (ROTEM) and thromboelastography (TEG) have been recommended for the treatment of postoperative bleeding after cardiac surgery because the ROTEM/TEG-guided treatment algorithms reduced the use of blood products. Other POC tests are commercially available, but there is sparse evidence for their routine use in cardiac surgery. These devices include heparin management systems, POC prothrombin time and activated partial thromboplastin time, POC fibrinogen assay, and whole blood platelet function tests. There are multiple confounding elements and conditions associated with cardiac surgery, which can significantly alter test results. Anemia and thrombocytopenia are regularly associated with deviations in many POC devices. In summary, POC coagulation testing allows for rapid clinical decisions in hematological interventions, and, when used in conjunction with a proper transfusion algorithm, may reduce blood product usage, and potentially complications associated with blood transfusion.

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Section: Coagulopathy After Cardiopulmonary Bypassmentioning

confidence: 99%

Section: Platelet Function Testingmentioning

confidence: 99%

Point-of-Care Coagulation Testing in Cardiac Surgery

Bolliger

Tanaka

2017

Semin Thromb Hemost

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“…15 However, at this time there is no consensus on the optimal fibrinogen level in patients undergoing surgery and a potential benefit of fibrinogen in patients undergoing surgery during DAPT is unknown. 16,17 In the present study, we tested the hypothesis that supplemental fibrinogen rescues thrombus formation in vitro in the presence of DAPT. Experiments were performed 1 in blood from healthy donors where acetylsalicylic acid and ticagrelor were added ex vivo and 2 in blood drawn from patients receiving acetylsalicylic acid and ticagrelor.…”

Section: Introductionmentioning

confidence: 99%

Supplemental Fibrinogen Restores Platelet Inhibitor-Induced Reduction in Thrombus Formation without Altering Platelet Function: An In Vitro Study

et al. 2020

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Background For patients treated with dual antiplatelet therapy, standardized drug-specific 3-to-7 day cessation is recommended prior to major surgery to reach sufficient platelet function recovery. Here we investigated the hypothesis that supplemental fibrinogen might mitigate the inhibitory effects of antiplatelet therapy. Methods and Results To this end blood from healthy donors was treated in vitro with platelet inhibitors, and in vitro thrombus formation and platelet activation were assessed. Ticagrelor, acetylsalicylic acid, the combination of both, and tirofiban all markedly attenuated the formation of adherent thrombi, when whole blood was perfused through collagen-coated microchannels at physiological shear rates. Addition of fibrinogen restored in vitro thrombus formation in the presence of antiplatelet drugs and heparin. However, platelet activation, as investigated in assays of P-selectin expression and calcium flux, was not altered by fibrinogen supplementation. Most importantly, fibrinogen was able to restore in vitro thrombogenesis in patients on maintenance dual antiplatelet therapy after percutaneous coronary intervention. Conclusion Thus, our in vitro data support the notion that supplementation of fibrinogen influences the perioperative hemostasis in patients undergoing surgery during antiplatelet therapy by promoting thrombogenesis without significantly interfering with platelet activation.

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“…If diagnosed quickly, surgical bleeding is a correctable cause of postoperative bleeding. 7 Otherwise, surgical bleeding can turn into the chicken that lays eggs of coagulopathy, adding to the negative effects of cardiopulmonary bypass on the coagulation system.…”

mentioning

confidence: 99%