Evaluation of a Novel Transfusion Algorithm Employing Point-of-care Coagulation Assays in Cardiac Surgery

Abstract

Institution of a transfusion algorithm based on point-of-care testing was associated with reduced transfusions. This suggests that the algorithm could improve the management of the many patients who develop coagulopathic bleeding after cardiac surgery. The generalizability of the findings needs to be confirmed.

Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study

“…42 Transfusion practice bundles that incorporate point-of-care coagulation testing may also achieve these objectives by reducing blood loss and transfusions through better management of coagulopathy. 43,44 Erythropoietin stimulating agents may also be used to correct preoperative anemia, thereby avoiding intraoperative anemia and RBC transfusion, 42 but the risk-benefit of this intervention in cardiac surgery has not been elucidated. 45 Other potential options that are currently undergoing evaluation include optimizing oxygen delivery by modifying pump flow; 46 washing of blood to remove the pro-inflammatory molecules, free hemoglobin, and iron that accumulate in the supernatant during storage; 47 haptoglobin therapy to scavenge the free hemoglobin that can be present after CPB and blood transfusion; 48 and prophylactic RBC transfusion one to two days before surgery in patients with preoperative anemia.…”

Bleeding risk assessment in patients undergoing elective cardiac surgery using ROTEM®platelet and Multiplate®impedance aggregometry

“…This is an important finding that clearly demonstrates the superiority of platelet function analysis using multiple (arachidonic acid, ADP and TRAP) compared with a single activator (ADP) approaches. Interventional studies using point‐of‐care platelet function analysis, particularly in combination with viscoelastic testing such as thromboelastometry (ROTEM), have been shown to be able to reduce peri‐operative bleeding and transfusion requirements as well as improve patient outcomes in cardiac surgery .…”

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

“…Thromboelastometry has already widely been used to monitor coagulation changes and to guide coagulation therapy in trauma patients [35,36,37,43,44,45,52,53,54], during liver transplantation [4,16,23,25,38,41,42,43,44,45,47,55,56], and during cardiac surgery [24,25,39,43,44,45,57,58,59,60,61]. …”