Patients With Severe Aortic Valve Stenosis and Impaired Platelet Function Benefit From Preoperative Desmopressin Infusion

Steinlechner, Barbara; Zeidler, Petra; Base, Eva; Birkenberg, Beatrice; Ankersmit, Hendrik Jan; Spannagl, Michael; Quehenberger, Peter; Hiesmayr, Michael; Jilma, Bernd

doi:10.1016/j.athoracsur.2011.01.052

Cited by 57 publications

(88 citation statements)

References 34 publications

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“…The standard dose is 0.3 µg/kg diluted in 50 ml saline and infused over 30 minutes [451]. Recently, it was shown that identification of impaired platelet function with a platelet function analyzer PFA-100 [454] or whole blood multiple electrode aggregometer [455] might be helpful in the identification of patients who may benefit from desmopressin therapy. The combined effect of platelet concentrates and subsequent administration of desmopressin has also been advocated to enhance the recovery of normal platelet function [456].…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsA comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.Please see related letter by Morel et alhttp://ccforum.com/content/17/4/442

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Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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“…Assessment of platelet dysfunction with PFA-100 in different clinical setting or in patients undergoing different kinds of elective surgeries, may provide useful information for postoperative blood transfusion management [106,107] . Especially in cardiac surgery PFA methodology showed a high predictive value of platelet function for management of intra-and postoperative blood loss [108][109][110][111] . In patients with biventricular assist device implantation on treatment with clopidogrel, the strict monitoring of impaired platelet function with this method (by using CADP cartridge) allowed them to go under successful transplantation with no major blood loss [112] .…”

Section: Platelet Function Point-of-care Testingmentioning

confidence: 99%

Assessment of platelet function: Laboratory and point-of-care methods

Paniccia¹

2014

WJTM

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In the event of blood vessel damage, human platelets are promptly recruited on the site of injury and, after their adhesion, activation and aggregation, prevent blood loss with the formation of a clot. The consequence of abnormal regulation can be either hemorrhage or the development of thrombosis. Qualitative and/or quantitative defects in platelets promote bleeding, whereas the residual reactivity of platelets, despite antiplatelet therapies, play an important role in promoting arterial thrombotic complications. Platelet function is traditionally assessed to investigate the origin of a bleeding syndrome, to predict the risk of bleeding prior surgery or during pregnancy or to monitor the efficacy of antiplatelet therapy in thrombotic syndromes that, now, can be considered a new discipline. "Old" platelet function laboratory tests such as the evaluation of bleeding time and the platelet aggregation analysis in platelet-rich plasma are traditionally utilized to aid in the diagnosis and management of patients with platelet and hemostatic disorders and used as diagnostic tools both in bleeding and thrombotic diathesis in specialized laboratories. Now, new and renewed automated systems have been introduced to provide a simple, rapid assessment of platelet function including point of care methods. These new methodologies are also suitable for being used in non-specialized laboratories and in critical area for assessing platelet function in whole blood without the requirement of sample processing. Some of these methods are also beginning to be incorporated into routine clinical use and can be utilized as not only as first panel for the diagnosis of platelet dysfunction, but also for monitoring anti-platelet therapy and to potentially assess risk of both bleeding and/or thrombosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Platelets; Method; Test; Point of care testing; Laboratory assessment; Bleeding; Thrombosis; Platelet function Core tip: This review discussed the scenario of available platelet function laboratory and point-of-care methods suitable in different clinical setting. As this matter has become of crucial importance in the bleeding management and for monitoring antiplatelet therapies, improved ability to assess platelet function in a timely and efficient manner is essential. Traditional platelet function methods, requiring a fair degree of expertise, have been limited to specialized laboratory. Many efforts have been carried out for improving platelet function assays for centralized laboratory, such as different point-of-care testing methodologies have been developed. Moreover, different guidelines and recommendations for their method standardization are growing.

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“…DDAVP and replacement of VWF may reduce bleeding symptoms in children with high shear stress lesions and reduced levels of high-molecular-weight multimers. In a double-blind, placebo-controlled trial, DDAVP was shown to reduce bleeding in adults undergoing aortic valve replacement for aortic stenosis, 32 although only a small subset of these patients had proven AVWS. Further, the risk of DDAVP-induced fluid overload and hyponatremia in the setting of these major surgeries should always be considered.…”

Section: Treatment Of Avws Caused By a Cardiovascular Diseasementioning

confidence: 99%

Treatment of acquired von Willebrand syndrome in childhood

Callaghan

Wong

Federici

2013

Blood

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A 3-1/2-year-old male with no personal or family history of bleeding disorders presented with abdominal distension, epistaxis, and anemia (hemoglobin 8.2 g/dL). A magnetic resonance imaging scan of the abdomen demonstrated a mass arising from the left kidney. Preoperative laboratory studies revealed a prolonged activated partial thromboplastin time of 49.2 seconds, a normal prothrombin time of 12.4 seconds, and a platelet count of 230 000/mL. Further testing revealed factor VIII (FVIII) activity of 16%, factor IX (FIX) activity of 74%, von Willebrand factor (VWF) activity of 12%, VWF antigen activity of 31%, and decreased high-molecular-weight VWF multimers consistent with acquired von

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Patients With Severe Aortic Valve Stenosis and Impaired Platelet Function Benefit From Preoperative Desmopressin Infusion

Cited by 57 publications

References 34 publications

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Assessment of platelet function: Laboratory and point-of-care methods

Treatment of acquired von Willebrand syndrome in childhood

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