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guidelines of transfusion in cardiopulmonary bypass surgery

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https://www.readbyqxmd.com/read/27378554/does-platelet-reactivity-predict-bleeding-in-patients-needing-urgent-coronary-artery-bypass-grafting-during-dual-antiplatelet-therapy
#1
Elisabeth Mahla, Florian Prueller, Sylvia Farzi, Gudrun Pregartner, Reinhard B Raggam, Elisabeth Beran, Wolfgang Toller, Andrea Berghold, Udaya S Tantry, Paul A Gurbel
BACKGROUND: Up to 15% of patients require coronary artery bypass grafting (CABG) during dual antiplatelet therapy. Available evidence suggests an association between platelet reactivity and CABG-related bleeding. However, platelet reactivity cutoffs for bleeding remain elusive. We sought to explore the association between platelet reactivity and bleeding. METHODS: Patients on aspirin and a P2Y12 receptor inhibitor within 48 hours before isolated CABG (n = 149) were enrolled in this prospective study...
December 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/25734869/perioperatively-acquired-disorders-of-coagulation
#2
REVIEW
Oliver Grottke, Dietmar Fries, Bartolomeu Nascimento
PURPOSE OF REVIEW: To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage. RECENT FINDINGS: Recent studies highlight the link between low fibrinogen and decreased fibrin polymerization in the development of acquired coagulopathy...
April 2015: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/25383671/platelet-transfusion-a-clinical-practice-guideline-from-the-aabb
#3
Richard M Kaufman, Benjamin Djulbegovic, Terry Gernsheimer, Steven Kleinman, Alan T Tinmouth, Kelley E Capocelli, Mark D Cipolle, Claudia S Cohn, Mark K Fung, Brenda J Grossman, Paul D Mintz, Barbara A O'Malley, Deborah A Sesok-Pizzini, Aryeh Shander, Gary E Stack, Kathryn E Webert, Robert Weinstein, Babu G Welch, Glenn J Whitman, Edward C Wong, Aaron A R Tobian
BACKGROUND: The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients. METHODS: These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework...
February 3, 2015: Annals of Internal Medicine
https://www.readbyqxmd.com/read/25002392/efficacy-of-near-infrared-spectrometry-for-monitoring-the-cerebral-effects-of-severe-dilutional-anemia
#4
COMPARATIVE STUDY
Arıtürk Cem, Ustalar Ozgen Zehra Serpil, Toraman Fevzi, Okten Murat, Güllü Umit, Erkek Esin, Uysal Pinar, Sensy Sahin, Karabulut Hasan, Alhan Cem
INTRODUCTION: Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO2) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG)...
June 2014: Heart Surgery Forum
https://www.readbyqxmd.com/read/24863631/the-influence-of-cardiopulmonary-bypass-priming-without-ffp-on-postoperative-coagulation-and-recovery-in-pediatric-patients-with-cyanotic-congenital-heart-disease
#5
RANDOMIZED CONTROLLED TRIAL
Xiaolei Miao, Jinping Liu, Mingxia Zhao, Yongli Cui, Zhengyi Feng, Ju Zhao, Cun Long, Shoujun Li, Fuxia Yan, Xu Wang, Shengshou Hu
UNLABELLED: Transfusion guidelines have been produced for the evidence-based use of fresh frozen plasma (FFP). However, the inappropriate use of FFP is still a worldwide problem, especially in the prophylactic settings. In the present study, 100 cyanotic pediatric patients (age 6 months to 3 years) undergoing cardiac surgery with cardiopulmonary bypass (CPB) were randomized to receive either 10-20 ml/kg FFP (FFP group, n = 50) or 10-20 ml/kg 4 % succinylated gelatin (Gelofusine, GEL group, n = 50) in the priming solution...
November 2014: European Journal of Pediatrics
https://www.readbyqxmd.com/read/24482391/blood-conservation-strategies-in-cardiac-surgery-more-is-better
#6
Dimitrios V Avgerinos, William DeBois, Arash Salemi
OBJECTIVES: Recent data show that up to 50% of heart procedures require blood transfusion, which can have adverse long- and short-term outcomes for the patient. This led to the updated 2011 Society of Thoracic Surgery (STS)/Society of Cardiovascular Anesthesiologists (SCA) guidelines in an attempt to adopt more effective blood conservation techniques. We present our results after the implementation of a more aggressive strategy for intraoperative blood conservation in cardiac surgery...
November 2014: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/24064204/impact-of-guideline-implementation-on-transfusion-practices-in-a-surgical-intensive-care-unit
#7
Jacob T Gutsche, Zev Noah Kornfield, Rebecca M Speck, Prakash A Patel, Pavan Atluri, John G Augoustides
BACKGROUND: Anemia is a common clinical problem in cardiac surgery patients in the postoperative period and may result in transfusion in up to 90% of this population. There is tremendous variation in transfusion rates by hospital and individual physician. It is unknown if implementation of a clinical practice guideline lowers unnecessary transfusion in hospital practices that already have a restrictive transfusion culture . OBJECTIVE: To evaluate transfusion practice before and after implementation of a clinical practice guideline...
December 2013: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/23820174/efficacy-and-safety-of-recombinant-factor-xiii-on-reducing-blood-transfusions-in-cardiac-surgery-a-randomized-placebo-controlled-multicenter-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Keyvan Karkouti, Christian von Heymann, Christian M Jespersen, Wolfgang Korte, Jerrold H Levy, Marco Ranucci, Frank W Sellke, Howard K Song
OBJECTIVES: Cardiac surgery with cardiopulmonary bypass frequently leads to excessive bleeding, obligating blood product transfusions. Because low factor XIII (FXIII) levels have been associated with bleeding after cardiac surgery, we investigated whether administering recombinant FXIII after cardiopulmonary bypass would reduce transfusions. METHODS: In this double-blinded, placebo-controlled, multicenter trial, 409 cardiac surgical patients at moderate risk for transfusion were randomized to receive an intravenous dose of recombinant FXIII, 17...
October 2013: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/23728087/is-elimination-of-cardiotomy-suction-preferable-in-aortic-valve-replacement-assessment-of-perioperative-coagulation-fibrinolysis-and-inflammation
#9
COMPARATIVE STUDY
Akimasa Morisaki, Atsushi Nakahira, Yasuyuki Sasaki, Hidekazu Hirai, Yuko Okada, Shigefumi Suehiro, Toshihiko Shibata
OBJECTIVES: Guidelines recommend the avoidance of direct return of pericardial blood based on evidence from coronary surgery. A continuous auto-transfusion system (CATS) can be a good alternative to cardiotomy suction by reinfusing aspirated pericardial blood without the necessity of intermittent collection. To clarify the effects of direct return of pericardial blood in aortic valve replacement (AVR), we compared the effects of cardiotomy suction and an alternative CATS on perioperative coagulofibrinolysis and inflammation systems, and clinical outcomes...
September 2013: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/23271047/evaluation-of-coagulation-factors-and-platelet-function-from-an-off-line-modified-ultrafiltration-technique-for-post-cardiopulmonary-bypass-circuit-blood-recovery
#10
MULTICENTER STUDY
S Beckmann, P Lynn, S Miller, R Harris, R F DiMarco, J E Ross
Modified ultrafiltration (MUF) is a technique that hemoconcentrates residual CPB circuit blood and the patient at the same time. Hemoconcentration and MUF are Class 1-A recommendations in the anesthesia and surgical blood conservation guidelines. This study evaluated the off-line MUF process of the Hemobag (HB, Global Blood Resources, Somers, CT, USA) to quantitate coagulation factor levels, platelet (PLT) count and function in one facility and cellular growth factor concentrations of the final product that were transfused to the patient in another facility In two cardiac surgery facilities, after decannulation, the extracorporeal circuit (ECC) blood from 22 patients undergoing cardiac surgery was processed with the HB device...
May 2013: Perfusion
https://www.readbyqxmd.com/read/23136809/sickle-cell-anaemia-and-the-consequences-on-the-anaesthetic-management-of-cardiac-surgery
#11
REVIEW
I Mennes, M Van de Velde, C Missant
A review of the available literature on genetics and pathophysiology of Sickle Cell Anaemia was performed with special emphasis on the intraoperative management during cardiac surgery. Hypoxia, acidosis and hypothermia have been identified as independent sickling provoking factors. Although no official guidelines on transfusion for Sickle Cell patients have been published, useful directives on preoperative transfusion could be derived from available data. Additionally, we bundled and reviewed the published expertise in the management of cardiopulmonary bypass and the necessity of hypothermia during cardiac surgery in Sickle Cell patients...
2012: Acta Anaesthesiologica Belgica
https://www.readbyqxmd.com/read/23123988/drug-devices-technologies-and-techniques-for-blood-management-in-minimally-invasive-and-conventional-cardiothoracic-surgery-a-consensus-statement-from-the-international-society-for-minimally-invasive-cardiothoracic-surgery-ismics-2011
#12
Alan H Menkis, Janet Martin, Davy C H Cheng, David C Fitzgerald, John J Freedman, Changqing Gao, Andreas Koster, G Scott Mackenzie, Gavin J Murphy, Bruce Spiess, Niv Ad
OBJECTIVE: The objectives of this consensus conference were to evaluate the evidence for the efficacy and safety of perioperative drugs, technologies, and techniques in reducing allogeneic blood transfusion for adults undergoing cardiac surgery and to develop evidence-based recommendations for comprehensive perioperative blood management in cardiac surgery, with emphasis on minimally invasive cardiac surgery. METHODS: The consensus panel short-listed the potential topics for review from a comprehensive list of potential drugs, devices, technologies, and techniques...
July 2012: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/22408766/safety-of-esophagogastroduodenoscopy-within-30-days-of-myocardial-infarction-a-retrospective-cohort-study-from-a-canadian-tertiary-centre
#13
Fahad Al-Ebrahim, Khurram J Khan, Waleed Alhazzani, Ahmed Alnemer, Abdullah Alzahrani, John Marshall, David Armstrong
BACKGROUND: Patients who experience myocardial infarction (MI) are at risk of gastrointestinal (GI) bleeding complications. Endoscopic evaluation may lead to cardiopulmonary complications. Guidelines and studies regarding the safety of endoscopy in this population are limited. OBJECTIVE: To evaluate the safety of endoscopy in a retrospective cohort of post-MI patients at a Canadian tertiary centre. METHODS: Using hospital diagnostic⁄procedure codes, the charts of patients meeting the inclusion criteria of having ST elevation MI or non-ST elevation MI, and GI bleeding detected at endoscopy were reviewed...
March 2012: Canadian Journal of Gastroenterology, Journal Canadien de Gastroenterologie
https://www.readbyqxmd.com/read/21938226/platelet-audit-assessment-and-utilization-of-this-precious-resource-from-a-tertiary-care-hospital
#14
K Saluja, B Thakral, N Marwaha, R R Sharma
BACKGROUND: To assess the appropriate utilization of platelet transfusions [random donor platelets (RDP) and single donor platelets (SDP)]; a six-month retrospective audit was carried out in a tertiary care hospital. MATERIALS AND METHODS: A six-month retrospective platelet audit was carried out from May to October 2005 to estimate its preparation, appropriate utilization and wastage rate. Patient's demographics, transfusion triggers and episodes and ABO and Rh (D) group specific or non-group specific transfusions were also assessed...
January 2007: Asian Journal of Transfusion Science
https://www.readbyqxmd.com/read/21790621/a-randomized-controlled-pilot-study-of-adherence-to-transfusion-strategies-in-cardiac-surgery
#15
RANDOMIZED CONTROLLED TRIAL
Nadine Shehata, Laura Alexandra Burns, Howard Nathan, Paul Hebert, Gregory M T Hare, Dean Fergusson, C David Mazer
BACKGROUND: It is important to determine the optimal hemoglobin (Hb) concentration for red blood cell (RBC) transfusion for patients undergoing cardiac surgery because increased mortality has been associated with the severity of anemia and exposure to RBCs. Because a definitive trial will require thousands of patients, and because there is variability in transfusion practices, a pilot study was undertaken to determine adherence to proposed strategies. STUDY DESIGN AND METHODS: A single-center parallel randomized controlled pilot trial was conducted in high-risk cardiac patients to assess adherence to two transfusion strategies...
January 2012: Transfusion
https://www.readbyqxmd.com/read/21497509/is-chronic-obstructive-pulmonary-disease-an-independent-risk-factor-for-transfusion-in-coronary-artery-bypass-graft-surgery
#16
Lacey M Stelle, Theresa M Boley, Stephen J Markwell, Stephen R Hazelrigg, Christina M Vassileva
OBJECTIVE: The literature is inconsistent regarding the role of chronic obstructive pulmonary disease (COPD) as a risk factor for blood product transfusion during coronary artery bypass graft (CABG). One reason may be lack of objective criteria to define COPD in previously published reports. We examined the role of COPD as a risk factor for transfusion using a strict definition based on objective pulmonary function test (PFT) data. METHODS: We identified 180 patients, who underwent primary isolated non-emergent CABG and had PFTs performed preoperatively...
December 2011: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/21429869/tepid-hypothermic-32%C3%A2-c-circulatory-arrest-for-total-aortic-arch-replacement-a-paradigm-shift-from-profound-hypothermic-surgery
#17
COMPARATIVE STUDY
Go Watanabe, Hiroshi Ohtake, Shigeyuki Tomita, Shohjiro Yamaguchi, Keiichi Kimura, Noriyoshi Yashiki
In total aortic arch replacement (TARCH) using hypothermic circulatory arrest (HCA) and selective cerebral perfusion (SCP), postoperative cerebral complications, including metabolic abnormalities, are by no means rare. Furthermore, there is a lack of international guidelines for the optimal perfusion temperature and flow for SCP. Starting in 2008, TARCH was performed using tepid HCA at 32 °C. In the present study, 27 patients (group C) who underwent TARCH with deep hypothermia at the lowest rectal temperatures of 20-25 °C were retrospectively reviewed and compared with 23 patients (group W) who underwent TARCH with 32 °C tepid hypothermia...
June 2011: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/21087706/randomized-controlled-trial-of-individualized-heparin-and-protamine-management-in-infants-undergoing-cardiac-surgery-with-cardiopulmonary-bypass
#18
RANDOMIZED CONTROLLED TRIAL
Colleen E Gruenwald, Cedric Manlhiot, Anthony K Chan, Lynn Crawford-Lean, Celeste Foreman, Helen M Holtby, Glen S Van Arsdell, Ross Richards, Helen Moriarty, Brian W McCrindle
OBJECTIVES: We sought to determine whether infants (younger than 1 year old) had similar clinical benefits with individualized anticoagulation management as older children and adult undergoing cardiopulmonary bypass (CPB). BACKGROUND: Individualized heparin and protamine management in older children and adults undergoing CPB has been associated with improved clinical outcomes. METHODS: Ninety infants younger than 1 year of age undergoing CPB were enrolled in a randomized, controlled trial comparing weight-based anticoagulation management using activated clotting time (ACT) to individualized management with Hemostasis Management System Plus...
November 23, 2010: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/20434109/bloodless-and-non-inotropic-cardiac-surgery-under-closed-circuit-anesthesia
#19
Chia-Chen Wu, Shung-Tai Ho, Chung-Yuan Lin, Fan-Yen Lee
BACKGROUND: The safety of homologous blood transfusion has become a major concern for patients and physicians. Current transfusion practice is highly variable and may be associated with inappropriate blood use. Inotropic agents have been almost routinely administered perioperatively to patients undergoing cardiac surgery to overcome low cardiac output due to cardiopulmonary bypass (CPB) and cardioplegia-induced cardiac ischemic arrest. In this study, we evaluated the feasibility of bloodless and non-inotropic open-heart surgery...
March 2010: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/19950738/intraoperative-minimal-acute-normovolemic-hemodilution-in-patients-undergoing-coronary-artery-bypass-surgery
#20
RANDOMIZED CONTROLLED TRIAL
Alireza Mahoori, Farhad Heshmati, Heydar Noroozinia, Hamid Mehdizadeh, Shahyad Salehi, Mojtaba Rohani
BACKGROUND & OBJECTIVE: Efficacy of minimal acute normovolemic hemodilution (ANH) in avoiding homologous blood transfusion during cardiovascular surgery remains controversial. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. Our objective was to evaluate the impact of minimal ANH on blood transfusion requirements during open cardiovascular surgery using cardiopulmonary bypass (CPB). METHODS: This study was a randomized controlled trial...
October 2009: Middle East Journal of Anesthesiology
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