Intra‐operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study

Al-Riyami, Arwa Z.; Al-Khabori, Murtadha; Baskaran, Balan; Siddiqi, Mohammad Salman; Al-Sabti, Hilal

doi:10.1111/vox.12280

Cited by 12 publications

(10 citation statements)

References 33 publications

(55 reference statements)

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“…This may explain the potential increase in the risk of FFP transfusion in the CS group. In a large study of over 600 patients from our centre , we found that the use of CS increases the rate of platelet and FFP transfusion consistent with the hypothesis of activated haemostasis in shed or CPB blood.…”

Section: Discussionsupporting

confidence: 76%

Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta‐analysis

et al. 2019

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Objective We performed a systematic review and meta‐analysis of randomized clinical trials on adult patients undergoing cardiac surgery and compared the rates of red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusion between the cell saver (CS) and the standard of care groups. Methods MEDLINE ®, The Cochrane Central Register of Controlled Trials (CENTRAL), American Society of Hematology (ASH) and bibliographies of relevant studies were searched. We used random‐effect model. Results Our search strategy returned 624 citations, of which 15 studies were selected. The use of CS did not decrease the rate of RBC transfusion (odds ratio [OR]: 0·69; 95% CI: 0·48–1·00), albeit with a substantial heterogeneity (I2 = 60%). The year of publication explained most of the heterogeneity (P for subgroup effect <0·001). Although the rate of platelet transfusion was lower in the CS group, the difference was not statistically significant (OR: 0·83; 95% CI: 0·57–1·2; I2 = 0%). The rate of FFP transfusion was numerically higher in the CS group; however, this difference did not reach statistical significance (OR: 1·26; 95% CI: 0·82–1·94; I2 = 15%). Only two studies scored five on the Jadad score. There was no indication of a publication bias using the funnel plot and Egger test (P = 0·34, 0·87, and 0·62 for RBC, platelet and FFP, respectively). Conclusion The use of CS during cardiac surgery does not have an impact on the rates of RBC, platelet and FFP transfusion; however, this should be interpreted in the light of the study limitations.

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Section: Discussionsupporting

confidence: 76%

Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta‐analysis

et al. 2019

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“…The use of cardiac bypass is known to cause extended bleeding times and is associated with increased post‐operative haemorrhage in patients with normal peripheral blood platelet counts. Hypothermia and heparin treatment are strongly inhibitory on platelet aggregation , and intraoperative cell salvage may cause acute platelet depletion . Moreover, the increasingly frequent use of aspirin and P2Y 12 inhibitors, such as clopidogrel, prasugrel and ticagrelor in acute coronary syndromes , often results in severe platelet inhibition during cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Impact of platelet pathogen inactivation on blood component utilization and patient safety in a large Austrian Regional Medical Centre

et al. 2016

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Background In clinical studies, pathogen inactivation (PI) of platelet concentrates (PC) with amotosalen and UVA light did not impact patient risk for haemorrhage but may affect transfusion frequency and component utilization. We evaluated the influence of platelet PI on PC, red cell concentrate (RCC) and plasma use and safety in routine practice in a large regional hospital. Study Design and MethodsComparative effectiveness of conventional vs. PI-treated PC was analysed during two 21-month periods, before and after PI implementation.Results Similar numbers of patients were transfused in the pre-PI (control, 1797) and post-PI (test, 1694) periods with comparable numbers of PC (8611 and 7705, respectively). The mean numbers of PC per patient transfused (4Á8 vs. 4Á5, P = 0Á43) were not different but days of PC support (5Á9 vs. 5Á0, P < 0Á01) decreased. Most patients received RCC (86Á8% control vs. 84Á8% test, P = 0Á90) with similar mean numbers transfused (10Á8 vs. 10Á2 RCC, P = 0Á22), and fewer patients (55Á4% control vs. 44Á7% test, P < 0Á01) received less plasma units (mean 9Á9 vs. 7Á8, respectively, P < 0Á01) in the test period. The frequencies of transfusion-related adverse events (AE) were comparable (1Á3% vs. 1Á4%, P = 0Á95). Analysis of haematology-oncology (522 control, 452 test), cardiac surgery (739 control, 711 test), paediatric (157 control, 130 test) and neonate (23 control, 20 test) patients revealed no increase in PC, plasma and RCC utilization, or AE.Conclusion Component utilization and patient safety were not impacted by adoption of PI for PC. RCC use per patient was comparable, suggestive of no increase in significant bleeding.

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“…No obstante, existen datos que declaran que la reinfusión de glóbulos rojos procedente del RC sin plaquetas, plasma, ni factores de coagulación, mitiga efectos negativos de la función hematológica del paciente, lo que justifica que en estos pacientes tengan una necesidad transfusional, sobre todo al consumo de factores de coagulación 25 , ya que provoca una sensibilización plaquetaria significativa, pero insistimos que no establecen un marco comparativo con aquellos pacientes que recibieron la transfusión sanguínea, por tanto coincidimos con otros estudios que postulan que toda investigación que se encauce en el uso de los recuperadores celulares como medida a la transfusión sanguínea, merecen precaución en cuanto su utilización de forma generalizada, por lo que requieren estudios más amplios para confirmar sus resultados 26 .…”

Section: Discussionunclassified

El recuperador celular y necesidad transfusional en pacientes intervenidos de cirugía cardíaca

Oliveros

2018

Rev Chil Cir

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Intra‐operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study

Abstract: The CS use increases platelet requirements and has no impact on the rate of RBC transfusion in our population. These findings warrant caution with generalized use and require larger studies to confirm its results.

Cited by 12 publications

References 33 publications

Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta‐analysis

Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta‐analysis

Impact of platelet pathogen inactivation on blood component utilization and patient safety in a large Austrian Regional Medical Centre

El recuperador celular y necesidad transfusional en pacientes intervenidos de cirugía cardíaca

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