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postoperative consumptive coagulopathy

Xinliang Guan, Jiachen Li, Ming Gong, Feng Lan, Hongjia Zhang
Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. However, the physiopathology of surgically induced coagulopathy has never been systematically and comprehensively studied in patients with acute aortic dissection. The aim of the present study was to describe the perioperative hemostatic system in patients with acute aortic dissection.The 87 patients who underwent aortic arch surgery for acute Stanford type A aortic dissection from January 2013 to September 2015 were enrolled in this study...
September 2016: Medicine (Baltimore)
Marco Ranucci
Cardiac surgery with cardiopulmonary bypass determines a serious imbalance of the hemostatic system. The clinical pattern is multifactorial, involving patient-related, drug-related, and surgery-related factors. As a result, the patient is prone to both hemorrhagic and thrombotic complications. To address the clinical management of a bleeding patient after cardiac surgery, avoiding empirical administration of drugs and blood derivates, it is mandatory to correctly identify the factor(s) responsible for bleeding...
February 2015: Seminars in Thrombosis and Hemostasis
John C LaMattina, Lars Burdorf, Tianshu Zhang, Elana Rybak, Xiangfei Cheng, Raghava Munivenkatappa, Isabelle I Salles, Katleen Broos, Evelyn Sievert, Brian McCormick, Marc Decarlo, David Ayares, Hans Deckmyn, Agnes M Azimzadeh, Richard N Pierson, Rolf N Barth
BACKGROUND: Although transplantation of genetically modified porcine livers into baboons has yielded recipient survival for up to 7 days, survival is limited by profound thrombocytopenia, which becomes manifest almost immediately after revascularization, and by subsequent coagulopathy. Porcine von Willebrand's factor (VWF), a glycoprotein that adheres to activated platelets to initiate thrombus formation, has been shown to constitutively activate human platelets via their glycoprotein Ib (GPIb) receptors...
May 2014: Xenotransplantation
Hayato Iwase, Mohamed B Ezzelarab, Burcin Ekser, David K C Cooper
Xenotransplantation could resolve the increasing discrepancy between the availability of deceased human donor organs and the demand for transplantation. Most advances in this field have resulted from the introduction of genetically engineered pigs, e.g., α1,3-galactosyltransferase gene-knockout (GTKO) pigs transgenic for one or more human complement-regulatory proteins (e.g., CD55, CD46, CD59). Failure of these grafts has not been associated with the classical features of acute humoral xenograft rejection, but with the development of thrombotic microangiopathy in the graft and/or consumptive coagulopathy in the recipient...
May 2014: Xenotransplantation
Marc G Lazarus, Thorsten M Smul, Norbert Roewer, Peter Kranke
Intra- and postoperative bleeding disorders are common in cardiac surgery. The etiology of perioperative coagulopathy frequently becomes apparent as a combination of several acquired and inherited disorders. Differential diagnosis of microvascular bleeding include altered homeostasis (e.g. anemia, hypothermia, acidosis, hypocalcemia), impaired primary hemostasis, antithrombotic medication, dilutive and consumptive coagulopathy, fibrinolysis and the absence or deficiency of coagulation factors. Timely detection of underlying pathology and subsequent rigorous treatment has the potential to minimize perioperative transfusion requirements, prevent resternotomy and improve patient outcome remarkably...
January 2014: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
S Sultan, M Sultan, N Hynes
AIM: We report mid-term results from the Global Independent multilayer flow modulator (MFM) registry using a uni-modular multilayer flow modulator stent technology. METHODS: We present the first 103 cases out of the 380 cases implanted in Europe under indications for use. All were done on a compassionate basis, in 12 countries, and were fully analyzed through the MFM registry. Primary endpoints were: one-year freedom from rupture and aneurysm-related death, one year all cause mortality, patency of visceral branches at one year, and one year incidence of stroke and paraplegia...
February 2014: Journal of Cardiovascular Surgery
H Kim, H K Chee, J Yang, S Hwang, K H Han, J Kang, J H Park, J S Kim, S J Lee, S A Ock, M H Park, K S Park, B C Lee, L Byeongchun, K Cho, J Noh, W Park, I J Yun, C Ahn
BACKGROUND: Solid organ xenotransplantation is a potential solution to current organ shortages in allotransplantation. We performed four heart transplantations from alpha1, 3-galactosyltransferase gene-knockout (GT-KO) pigs to cynomolgus monkeys and monitored immunological parameters before and after transplantation. METHODS: After blood typing of the cynomolgus monkeys, we assessed the binding activity of immunoglobulin G (IgG) and IgM of monkey serum and serum toxicity toward porcine peripheral blood mononuclear cells (PBMCs) using flow cytometry...
October 2013: Transplantation Proceedings
Jelka Masin-Spasovska, Koco Dimitrovski, Sotir Stavridis, Oliver Stankov, Saso Dohcev, Skender Saidi, Krume Jakovski, Trajan Balkanov, Nikola Labacevski, Viktor Stankov, Ljupco Lekovski, Goce Spasovski
INTRODUCTION: A liver dysfunction induced by halogenated volatile anaesthetics is considered as a significant diagnostic problem. The aim of our report was to describe the first case of lethal hepatic failure in a female patient undergoing kidney transplantation (KTx) from a living donor after repeated sevoflurane anaesthesia. CASE PRESENTATION: A 47-year-old hypertensive and diabetic female patient received kidney from her 70-year-old mother. There was an immediate graft function and around 800 ml of blood loss on the abdominal drains, which gradually decreased after the erythrocyte and fresh frozen plasma (FFP) substitution...
April 2013: Current Drug Safety
Christopher Allen-John Webb, Paul David Weyker, Vivek K Moitra, Richard K Raker
Anesthesiologists face several perioperative challenges when patients need cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion. To adequately care for these patients, anesthesiologists must understand the goals and objectives of the operation in addition to having a basic knowledge of the chemotherapeutic drugs that are frequently used. Optimal anesthetic management of patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion requires control of a complex interplay of physiologic mechanisms, including hyperthermia, abdominal hypertension, electrolyte abnormalities, coagulopathies, increased cardiac index, oxygen consumption, and decreased systemic vascular resistance...
April 2013: Anesthesia and Analgesia
Luca Spiezia, Massimo Boldrin, Claudia Radu, Cristiana Bulato, Diana Bertini, Maria Bon, Elena Campello, Marta Vadori, Cesare Galli, Sabrina Gavasso, Mark B Nottle, Peter J Cowan, Emanuele Cozzi, Paolo Simioni
BACKGROUND: Activation of the clotting cascade is central in acute xenograft rejection (AHXR) that occurs when pig organs are transplanted into primates. The coagulopathy reported in this model is a very complex process that involves simultaneously coagulation factors, platelets and phospholipid-bearing cells (i.e., leukocytes, red blood cells, and endothelial cells). Choosing whole blood for coagulation analysis theoretically appears more favorable compared with plasma. Whole blood rotation thromboelastometry (ROTEM(®) ) is a point-of-care global coagulation analyzer able to evaluate the characteristics of clot formation and lysis by dynamic monitoring...
March 2013: Xenotransplantation
J L Fernandez-Aguilar, M A Suarez-Muñoz, B Sanchez-Perez, E Gamez Cordoba, Y Pulido Roa, J Aranda Narvaez, A Perez Daga, C Montiel Casado, A Gonzalez Sanchez, J Santoyo Santoyo
This observational cohort compared 70 consecutive liver transplantations (OLT) with no intra-abdominal drain and 70 control subjects C with an intra-abdominal drain who were operated immediately prior to them. We sought to assess the impact of abdominal drainage on the diagnosis and prevention of early postoperative complications of hemoperitoneum, reinterventions, biliary leaks or percutaneous drainage. We assessed variables related to the recipient (age, indication, pretransplant ascites, body mass index, Model for End-stage Liver Disease score, and rejection episodes, to the donor (age, steatosis and, ischemia time) as well as intra- and postoperative factors (surgery time, blood product use, and coagulopathy)...
November 2012: Transplantation Proceedings
Natasha Gupta, Anu Gupta, Marlene Green, Hyung Shik Kang, Josef Blankstein
Placenta percreta in early pregnancy is an extremely rare but life-threatening complication, for which very few cases have been reported in the literature worldwide, none from the United States. We report a patient with two previous cesarean deliveries, who presented with incomplete abortion at 17 weeks and underwent dilatation and curettage. She was found to have retained, adherent placenta that led to extensive hemorrhage, requiring emergency supracervical hysterectomy. Postoperative course was also complicated by severe consumption coagulopathy, necessitating reexploration after hysterectomy...
2012: Case Reports in Obstetrics and Gynecology
A Sabate, A Dalmau, M Koo, I Aparicio, M Costa, L Contreras
Risk of bleeding and transfusion in liver transplantation is determined by age, severity of liver disease, as well as hemoglobin and plasma fibrinogen values. During the hepatectomy and the anhepatic phase, the coagulopathy is related to a decrease in clotting factors caused by surgical bleeding, facilitated by the increased portal hypertension and esophageal-gastric venous distension. Corrections of hematologic disturbances by administration of large volumes of crystalloid, colloid, or blood products may worsen the coagulopathy...
July 2012: Transplantation Proceedings
G Scrascia, C Rotunno, D Nanna, R Rociola, P Guida, G Rubino, L de Luca Tupputi Schinosa, D Paparella
Cell saving systems are commonly used during cardiac operations to improve hemoglobin levels and to reduce blood product requirements. We analyzed the effects of residual pump blood salvage through a cell saver on coagulation and fibrinolysis activation and on postoperative hemoglobin levels. Thirty-four elective coronary artery bypass graft (CABG) patients were randomized. In 17 patients, residual cardiopulmonary bypass (CPB) circuit blood was transfused after the cell saving procedure (cell salvage group)...
July 2012: Perfusion
Richard Herman, Shaun Kunisaki, Mark Molitor, Samir Gadepalli, Jonathan R Dillman, James Geiger
Klippel-Trénaunay syndrome (KTS) is a rare noninheritable congenital disorder comprising vascular malformations that predispose patients to a paradoxical condition where bleeding occurs in a hypercoagulable state. A 16-year-old boy with a complicated lifetime course of KTS presented with massive rectal bleeding. He underwent a partial colectomy, endorectal resection, and splenectomy. Postoperatively, he developed a saddle pulmonary embolus, ultimately requiring placement of an inferior vena cava filter. He eventually did well and has since had his diverting ostomy reversed and resumed his usual activities...
March 2012: Journal of Pediatric Surgery
Timothy J Cooksley, Philip Haji-Michael
BACKGROUND: Cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) results in a number of physiological changes with effects on the cardiovascular system, oxygen consumption and coagulation. The Critical Care interventions required by this cohort of patients have not yet been quantified. METHODS: This retrospective audit examines the experience of a Specialist Tertiary Centre in England over an 18 month period (January 2009-June 2010) during which 69 patients underwent CRS and HIPEC...
2011: World Journal of Surgical Oncology
J Fazakas, A Doros, A Smudla, S Tóth, B Nemes, L Kóbori
INTRODUCTION: Hepatic diseases decrease the liver's involvement in thermoregulation. Removal of the liver during transplantation increases the incidence of hypothermia during the surgery. The aims of the present study were to analyze the hemodynamic changes among hypothermic liver transplantations and to determine its relationship to postoperative complications. METHODS: Conventional and volumetric hemodynamic monitoring and intramucosal pH measurements were performed during 54 liver transplantations...
May 2011: Transplantation Proceedings
Darshit Atul Gandhi, Timothy Shrewsberry
A 69-year-old male, who underwent cardio-pulmonary bypass surgery, required biventricular support using the Abiomed. The patient subsequently developed a consumptive coagulopathy. The thromboelastograph was used to administer NovoSeven and guide allogenic transfusions to achieve a hematocrit of greater than 30% and a platelet count greater than 100,000 per microL. Disseminated intravascular coagulation was resolved and the patient was transported to a tertiary care center within 72 hours. The Abiomed BVS 5000 provided a bridge to the native heart recovery and was successfully explanted...
March 2011: Journal of Extra-corporeal Technology
Micheline Nguyen, Franck Vandenbroucke, Jean-Denis Roy, Danielle Beaulieu, Robert F Seal, Réal Lapointe, Michel Dagenais, André Roy, Luc Massicotte
BACKGROUND: Optimal modality of pain management after liver resection has been controversial. Epidural analgesia is often avoided because of transient coagulopathy and the associated risk of epidural hematoma. Single-dose intrathecal morphine has been shown to be an effective alternative in open liver resection. The purpose of this trial was to compare the analgesic efficacy of intrathecal morphine and fentanyl versus intrathecal bupivacaine 0.5%, morphine, and fentanyl for patients undergoing laparoscopic liver resection...
May 2010: Regional Anesthesia and Pain Medicine
Chenhong Wang, Xinzhi Tu, Shengli Li, Guoyang Luo, Errol R Norwitz
BACKGROUND: Spontaneous (non-traumatic) rupture of the spleen rarely occurs in the setting of a normal spleen, especially during pregnancy. OBJECTIVES: We report a case of spontaneous rupture of a normal spleen at 33.7 weeks gestation and review the literature with the aim of exploring the etiology, diagnosis, and management of this condition during pregnancy. CASE REPORT: A 30-year-old Chinese primigravida presented at 33.7 weeks gestation with acute onset of severe, constant left upper abdominal pain...
November 2011: Journal of Emergency Medicine
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