Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline

Ferraris, Victor A.; Ferraris, Suellen P.; Saha, Sibu P.; Hessel, Eugene A.; Haan, Constance K.; Royston, B.; Bridges, Charles R.; Higgins, Robert S.D.; Despotis, George J.; Brown, Jeremiah R.; Spiess, Bruce D.; Shore‐Lesserson, Linda; Stafford‐Smith, Mark; Mazer, C. David; Bennett‐Guerrero, Elliott; Hill, Steven E.; Body, Simon C.

doi:10.1016/j.athoracsur.2007.02.099

Cited by 856 publications

(680 citation statements)

References 647 publications

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“…However, there was no increased risk if the P2Y 12 blocker was stopped for 6 to seven days. This confirms the empiric advice in current practice guidelines36, that stopping P2Y 12 blockers for at least 5 days achieves the greatest reduction in bleeding risk.…”

Section: Discussionsupporting

confidence: 83%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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Section: Discussionsupporting

confidence: 83%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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“…The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists, after reviewing the available evidence base for these practices in cardiac surgery, have issued a recent, similar clinical practice guideline. 32 POVL is not mentioned in either guideline.…”

Section: Blood Lossmentioning

confidence: 99%

Perioperative visual loss: what do we know, what can we do?

Roth¹

2009

British Journal of Anaesthesia

255

116

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Perioperative visual loss (POVL), a rare, but devastating complication, can follow non-ocular surgery. Highest rates of visual loss are with cardiac and spine surgery. The main causes of visual loss after non-ocular surgery are retinal vascular occlusion and ischaemic optic neuropathy. This review updates readers on the incidence, suspected risk factors, diagnosis, and treatment of POVL due to these conditions. Br J Anaesth 2009; 103 (Suppl. 1): i31-i40Keywords: complications, neurological; complications, neuropathy; eye, intraocular pressure; eye, pupil; surgery, spinal Visual loss after anaesthesia and surgery is a rare, unexpected, and devastating complication. Clinicians have suspected that incidence is increasing, particularly with spinal fusion surgery; however, recent data suggest that this may not be the case. This review will update readers on the incidence, suspected risk factors, diagnosis, and treatment of perioperative visual loss (POVL), in the setting of non-ocular surgery. The causes of POVL are primarily retinal vascular occlusion (RVO) and ischaemic optic neuropathy (ION). The relevant anatomy of the ocular circulation has been reviewed elsewhere and is summarized in Figure 1. 80 Other sources are glycine toxicity during transurethral resection of the prostate, acute angle closure glaucoma, cortical blindness, and expansion of an intraocular sulphur hexafluoride vitrectomy bubble by administration of nitrous oxide. As these are less common, the reader is referred for details to a recent more inclusive review. 80

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“…Analogous of the lisine, such as the EACA and tranexamic acid, are indicated for reducing the need of transfusion and reducing the total loss of blood. These agents are less effective than the aprotinine and its security requires additional studies [11]. Recently, the sales of aprotinine were temporarily suspended by the laboratory responsible for its production, and this decision was based on the information supplied by the Canadian Study Executive Commission BART (The Blood Conservation Using Antifibrinolytics in a Randomized Trial), whose preliminary results demonstrated that the benefits of the drugs administration in blood reduction were not sufficient for maintaining the continuity of the study [12].…”

Section: Discussionmentioning

confidence: 99%

Uso tópico de agente antifibrinolítico na redução do sangramento após revascularização cirúrgica do miocárdio

Breda¹,

Gurian²,

Breda³

et al. 2009

Rev Bras Cir Cardiovasc

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Uso tópico de agente antifibrinolítico na redução do sangramento após revascularização cirúrgica do miocárdioTopical use of antifibrinolytic agent to reduce postoperative bleeding after coronary artery bypass surgery Abstract Objective: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery.Methods: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were compared according the preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated.Results

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Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline

Cited by 856 publications

References 647 publications

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Perioperative visual loss: what do we know, what can we do?

Uso tópico de agente antifibrinolítico na redução do sangramento após revascularização cirúrgica do miocárdio

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