Hemostatic alterations during coronary artery bypass grafting

Gielen, Chantal L.I.; Brand, Anneke; Heerde, Waander L. van; Stijnen, Theo; Klautz, Robert J.M.; Eikenboom, Jeroen

doi:10.1016/j.thromres.2015.12.018

Cited by 21 publications

(18 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If excessive microvascular bleeding is present after heparin reversal, an assessment of platelets (PLT) and fibrinogen is required in addition to evaluation for coagulation factors deficiency. It is also important to remember that CPB is associated with significant fibrinolysis, 46,47 and therefore the use of antifibrinolytic agents [48][49][50] should be continued beyond the operating room, or restarted if already discontinued, in cases with excessive postoperative bleeding. 51,52 Patients may require transfusion of a single component but frequently more than one component is required to achieve adequate hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Raphael

Mazer

Subramani

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point of care coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, has increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has declined only modestly over the last decade, remaining at 50% or greater in high-risk patients. Given these limitations and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists has formed the Blood Conservation in Cardiac Surgery Working Group in order to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.

show abstract

Section: Discussionmentioning

confidence: 99%

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Raphael

Mazer

Subramani

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

show abstract

“…A limited number of studies have compared the effects of ONCAB versus OPCAB on platelet activation and aggregation and failed to demonstrate major differences between them 30, 33, 34, 35. It should be emphasized that these studies relied on measurements of platelet function ex vivo, which do not necessarily reflect the extent of platelet activation in vivo 31…”

Section: Differences In Systemic Inflammatory Reaction and Platelet/cmentioning

confidence: 99%

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Gaudino

Angelini

Antoniades

et al. 2018

JAHA

View full text Add to dashboard Cite

“…Furthermore, thrombin release caused by surgery itself will activate platelets with a subsequent effect on coagulation. Moreover, platelet count in circulating blood decreases substantially during CPB, and a low postoperative platelet count has been associated with increased postoperative blood loss . The remaining platelets show an impaired response capacity to stimulation, and even if they recover within a few days, this is problematic as their contribution to coagulation during the first hours after surgery is critical.…”

Section: Introductionmentioning

confidence: 99%

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Kjellberg

Holm

Lindvall

et al. 2020

Transfusion Medicine

View full text Add to dashboard Cite

Objectives: The aim of this study was to investigate whether ROTEM platelet can provide additional information to the traditional ROTEM analysis to guide treatment with platelet transfusions in cardiac surgery and to identify factors triggering platelet administration. Background: Platelets play a crucial role in coagulation and haemostasis after cardiac surgery. Excessive bleeding after cardiopulmonary bypass usually requires transfusions of blood products, including platelets. The ROTEM platelet is a novel point-ofcare analysis for whole blood. Materials and methods: We included 23 patients scheduled for complex cardiac surgery. ROTEM (in-tem, ex-tem), ROTEM platelet (ARA-tem, ADP-tem and TRAP-tem) and platelet count were analysed before induction of anaesthesia (T0), after cardiopulmonary bypass and protamine reversal (T1) and after platelet transfusion (T2, n = 10). Results: ROTEM and ROTEM platelet tests were all significantly reduced between T0 and T1. ROTEM parameters improved significantly after platelet transfusion. Regarding ROTEM platelet, only TRAP-tem increased between T1 and T2 (P = .008). Factors triggering platelet transfusion were long duration of surgery and time on cardiopulmonary bypass. Conclusion: ROTEM platelet with thrombin activation, TRAP-tem, improved significantly, indicating that platelet transfusion may reverse cardiopulmonary bypassinduced platelet dysfunction. Further studies are needed to evaluate whether TRAPtem can be a valuable analysis regarding indications for transfusion of platelets after extensive cardiac surgery.

show abstract

Hemostatic alterations during coronary artery bypass grafting

Cited by 21 publications

References 19 publications

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Contact Info

Product

Resources

About