Use of laboratory testing for prediction of postoperative bleeding volume in cardiovascular surgery

Kawahara, Yoshie; Ohtsuka, Kohei; Tanaka, Kimine; Yamanaka, Masashi; Kamiya, Hiroyuki; Kunisawa, Takayuki; Fujii, Satoshi

doi:10.1186/s12959-021-00324-4

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…12,16 Preoperative FVIII was elevated in 35% of patients with elective coronary artery bypass graft (CABG) in the study of Ternström et al, 13 and the mean baseline FVIII was within the normal range in patients undergoing various cardiac surgeries. 17 The most striking finding of our study was the marked FVIII elevation after PEA. Although previous reports indicate that PEA upregulates FVIII 1 to 3 days after surgery, 14 and that FVIII levels revert to baseline levels 1 year after successful PEA, 5 our study provides details on the temporal FVIII changes after surgery.…”

Section: Discussionsupporting

confidence: 55%

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Upregulation of Coagulation Factor VIII and Fibrinogen After Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Myllylahti

Ropponen

Lax

et al. 2023

Clin Appl Thromb Hemost

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Objectives Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with thrombotic states including elevated coagulation factor VIII (FVIII). Pulmonary endarterectomy (PEA) is the main treatment for CTEPH, and efficient anticoagulation is essential to prevent thromboembolism recurrence after surgery. We aimed to characterize longitudinal changes in FVIII and other coagulation biomarkers after PEA. Methods Coagulation biomarker levels were measured at baseline and up to 12 months after operation in 17 consecutive patients with PEA. Temporal patterns of coagulation biomarkers, and correlation of FVIII with other coagulation biomarkers, were analyzed. Results Baseline FVIII levels were elevated in 71% of the patients (mean 216 ± 67 IU/dl). FVIII doubled 7 days after PEA, peaking at 471 ± 87 IU/dl, and gradually returned to respective baseline levels within 3 months. Postoperative fibrinogen levels were also elevated. Antithrombin decreased at 1 to 3 days, D-dimer increased at 1 to 4 weeks, and thrombocytosis was observed at 2 weeks. Conclusions FVIII is elevated in most patients with CTEPH. After PEA, early but transient elevation of FVIII and fibrinogen, and delayed reactive thrombocytosis, occurs, and warrants careful postoperative anticoagulation to prevent thromboembolism recurrence.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Upregulation of Coagulation Factor VIII and Fibrinogen After Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Myllylahti

Ropponen

Lax

et al. 2023

Clin Appl Thromb Hemost

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“…Actually, in a previous report of cardiovascular surgery, coagulofibrinolytic markers including TAT reflected surgical stress and were associated with bleeding volume. [ 12 ] Although UFH could not be started because of the patient’s bleeding tendency, long-term ECMO management was made possible in this case by controlling the excessive activation of coagulation by exchanging circuits at the required time. Considering the social aspects of the COVID-19 epidemic and treatment cost, optimal anticoagulant management for COVID-19-associated coagulopathy, and EIC should be established.…”

Section: Discussionmentioning

confidence: 99%

Dynamic coagulofibrinolytic responses under long-term VV-ECMO management without anticoagulation in a COVID-19-ARDS patient: A case report

et al. 2023

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Rationale: Venovenous extracorporeal membrane oxygenation (ECMO) is recommended for the treatment of critically ill patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19). However, ECMO management can cause both bleeding and thrombotic complications. There are insufficient coagulofibrinolytic data for appropriate ECMO management in patients with COVID-19. Patient concerns: A 48-year-old man with severe COVID-19-acute respiratory distress syndrome underwent long-term venovenous ECMO management for 48 days. Refractory oronasal bleeding developed on day 13, so the administration of unfractionated heparin was ceased for 29 days. Diagnosis: The patient showed dynamic coagulofibrinolytic responses associated with ECMO management, as shown by fibrin/fibrinogen degradation products, soluble fibrin, thrombin-antithrombin complex, and plasmin-α2-plasmin inhibitor complex elevations, suggesting the development of ECMO-induced coagulopathy. Interventions: We assessed coagulofibrinolytic markers to decide the appropriate timing for controlling excessive activation of coagulation by exchanging ECMO circuits. Moreover, viscoelastic hemostatic assays were used for adequate transfusion of blood products. Outcomes: Safe long-term ECMO management was completed, which was withdrawn on day 48. The patient was weaned off mechanical ventilation on day 57 and was transferred to another hospital for rehabilitation. Lessons: Monitoring the coagulofibrinolytic status using markers and viscoelastic hemostatic assays may be effective for safe long-term ECMO management even without anticoagulant therapy.

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“…Basic laboratory testing includes determination of international normalized ratio (INR), activated partial thromboplastin time (APTT) and fibrinogen levels (FIBC). Patients with INR and APTT ratio > 1.5 as well as fibrinogen level < 1 g/L are at a high risk of bleeding during surgery [155]. The results of these laboratory test will provide justification to take remedial steps to correct identified coagulopathic status and clinically indicated pharmacologic (antifibrinolytic agents like tranexamic acid, vitamin K, prothrombin complex concentrate, fibrinogen concentrate) or management with blood products (FFP, cryoprecipitate and platelet concentrate).…”

Section: Best Practices In Pre-operative Planning and Management Of T...mentioning

confidence: 99%

Optimizing Blood Transfusion Service Delivery across the West African Sub-Region

Erhabor,

O. Akpotuzor,

Yaw Afriyie

et al. 2023

Thalassemia Syndromes - New Insights and Transfusion Modalities

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The sub-continent of West Africa is made up of 16 countries: Benin, Burkina Faso, Cape Verde, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Gambia and Togo. As of 2018, the population of the sub-continent was estimated at about 381 million. The main challenge associated with blood transfusion service delivery across the sub-region concerns adequacy and safety. In this chapter, we highlighted the challenges associated with the delivery of a quality blood transfusion service in countries in the sub-region including: implementation of component therapy rather than whole blood transfusion, effective cold chain management of blood and blood products, alloimmunization prevention, implementation of column agglutination and automation rather than the convention manual tube method in blood transfusion testing, effective management of major haemorrhage, optimization of screening for transfusion transmissible infections, optimizing blood donation, implementation of universal leucodepletion of blood and blood products, effective management of transfusion-dependent patients, pre-operative planning and management of surgical patients, management of Rhesus D negative pregnancy and women with clinically significant alloantibodies, implementation of haemovigilance system, implementation of alternatives to allogenic blood, availability and use of specialized blood products, optimizing safe blood donation, enhancing blood transfusion safety, operating a quality management system-based blood transfusion service and implementation of non-invasive cell-free foetal DNA testing. There is the urgent need for the implementation of evidence-based best practices in blood transfusion service delivery across the sub-region to allow for excellent, safe, adequate and timely blood transfusion service delivery across the sub-region.

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Use of laboratory testing for prediction of postoperative bleeding volume in cardiovascular surgery

Cited by 8 publications

References 13 publications

Upregulation of Coagulation Factor VIII and Fibrinogen After Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Upregulation of Coagulation Factor VIII and Fibrinogen After Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Dynamic coagulofibrinolytic responses under long-term VV-ECMO management without anticoagulation in a COVID-19-ARDS patient: A case report

Optimizing Blood Transfusion Service Delivery across the West African Sub-Region

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