Tolerating anemia: taking aim at the right target before pulling the transfusion trigger

Koch, Colleen G.

doi:10.1111/trf.12832

Cited by 10 publications

(12 citation statements)

References 18 publications

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“…The answer to the question seeks to balance risk and benefits of transfusion and anemia, while understanding that risks may be different for the individual patients and organ systems, as well as recognizing an ability for both to respond adaptively to acute anemia. 15,16 We currently lack technology to detect anemia-related tissue hypoxia in real time and the influence of the perioperative milieu and patient-specific factors on the overlay of acute anemia. Although we currently are unable to get it ''just right'' for each individual patient, results from trials such as that of Mazer and colleagues 2,3 provide us data that will move us further away from overuse and allow us to contribute to reductions in overall health care waste.…”

Section: Discussionmentioning

confidence: 99%

The Goldilocks principle and perioperative red blood cell transfusion: Overuse, underuse, getting it just right

Hensley

Brown

Frank

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

The Goldilocks principle and perioperative red blood cell transfusion: Overuse, underuse, getting it just right

Hensley

Brown

Frank

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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“…Moreover, cardiac surgery was a branch of surgery that consumed the largest amounts of blood, just before orthopedic surgery (11,12). Transfusion is often necessary during cardiovascular surgery to cure coagulopathy, blood loss, and hemodilution due to priming (13). Very often, patients who undergo cardiac surgery have numerous comorbidities such as anemia or myocardial infarction, which increase the risk of complications, and therefore the need for blood transfusion is higher (10,11,14).…”

Section: Discussionmentioning

confidence: 99%

Disorders of Coagulation Status and Haemostasis as Prognostic Parameters of Immediate and Early Results After Surgical Myocardial Revascularisation

Milić¹,

Lazarević²,

Bogdanović³

et al. 2019

AMM

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Surgical myocardial revascularization is one of the most commonly performed surgical procedures in the world. Over time, with the development of technology and modern diagnostic procedures, as well as the advancement of surgical techniques, the mortality rate for elective uncomplicated cases has fallen to below 2%. Nevertheless, despite the exceptional development of the surgical techiniques, the rate of postoperative complications, that can compromise the patients, is over 10%. The aim of this study was to define a group of patients with an increased risk of postoperative complications depending on the disorders of coagulation status and haemostasis. Twenty eight patients who underwent surgical revascularization of the myocardium were included in this prospective, non-randomized study. The study was conducted at the Clinic for Cardiac Surgery, Clinical Center Nis, from January to April 2017. Preoperatively as well as 3 hours, 24 hours, 48 hours, 3 days, and 5 days postoperatively, the following parameters were determined: blood count, inflammation parameters (C reactive protein, presepsin); coagulation status (prothrombin time (PT), International Normalized Ratio (INR), activated partial thromboplastin time (APTT), fibrinogen, anti-thrombin III, D dimer). The only preoperative independent prognostic parameter for increased postoperative drainage was INR. Activated clothing time (ACT) was an independent postoperative prognostic parameter of increased postoperative drainage, probably due to delayed or prolonged heparin activity. Inflammation parameters showed no association with the onset of postoperative complications. In relation to patients without bleeding, in patients with bleeding, significantly higher values of urea and the difference in APTT values, preoperatively and at the end of the monitoring period, were detected. Multivariate logistic regression analysis, confirmed the difference in APTT values preoperatively and at the end of the monitoring period, as the only factor, significantly associated with the risk of bleeding. Multivariate linear regression analysis, confirmed the value of the urea, as the only factor significantly associated with the change in total allogeneic transfusion value. Increase in urea levels is associated with an increase in the total amount of allogeneic transfusion. Correlation analysis showed that the increased number of days in the intensive care was significantly associated with female gender, number of grafts, prolonged ECC, clamping time, hematocrit (HCT), PT, INR preoperatively and at the end of the follow-up period. Surgical myocardial revascularization is a safe method with a minimal morbidity rate. Using of modern methods for the preoperative monitoring of haemostasis may significantly reduce the risk of postoperative bleeding and the need for transfusion of red blood cells and other blood derivatives.

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“…Reducing the hematocrit trigger to 24% in patients having cardiac surgery did not worsen outcome, but reduced overall RBC use compared with a 28% transfusion trigger. A recent editorial highlighted the complexity underlying recommendations for a uniformly applicable transfusion trigger [1]. Advocates for tolerating lower hematocrit triggers point to reduction in RBC use, whereas others state that additional factors should be considered, such as comorbidity burden, individual organ responses to varying levels of anemia, and acute exposure to hemodilution and blood loss.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there is interplay between lower levels of hematocrit, a patient's ability to adapt, and a specific organ's tolerance. Larger percentage reductions in hemoglobin from baseline are associated with worse outcomes [1,28]. That may relate to an inability to adapt to an acute reduction in hematocrit.…”

Section: Discussionmentioning

confidence: 99%

“…(Ann Thorac Surg 2017;104:1243-50) Ó 2017 by The Society of Thoracic Surgeons P rocedural complexity and comorbidity burden contribute to high red blood cell (RBC) use in cardiac surgery. Class I evidence supporting when to transfuse has been elusive, leading to substantial practice variation [1][2][3][4]. Furthermore, physiologic response to low hematocrit may be masked by perioperative medications, intentional hypothermia and hemodilution, and fluid shifts; direct biomarkers of tissue hypoxemia are generally unavailable to guide transfusion decisions [5][6][7][8].…”

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confidence: 99%

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A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in Cardiac Surgery

Koch

Sessler

Mascha

et al. 2017

The Annals of Thoracic Surgery

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Tolerating anemia: taking aim at the right target before pulling the transfusion trigger

Cited by 10 publications

References 18 publications

The Goldilocks principle and perioperative red blood cell transfusion: Overuse, underuse, getting it just right

The Goldilocks principle and perioperative red blood cell transfusion: Overuse, underuse, getting it just right

Disorders of Coagulation Status and Haemostasis as Prognostic Parameters of Immediate and Early Results After Surgical Myocardial Revascularisation

A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in Cardiac Surgery

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