Un petit peu de connaissances sur la coagulation peut s’avérer dangereux!

Spiess, Bruce D.

doi:10.1007/s12630-009-9107-9

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…UFH is the most widely influencing drug we use. Unfractionated heparin binds to and reacts with 22% of the proteins circulating in blood (23)(24)(25). It does not just activate anti-thrombin III thereby leading to the secondary anticoagulant effect that we use for bypass.…”

Section: Heparin Anticoagulationmentioning

confidence: 99%

Blood Management—Issues: The Panic of Coagulopathic Bleeding—Is There a Rational Approach?

Spiess

2011

J Extra Corpor Technol

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Blood management is an evolving field of reducing transfusions of allogeneic blood by maximizing multi-modality therapy to optimize red cell mass, reduce red cell loss, and harvest red cells that would have otherwise been discarded. These techniques are highly dependent upon teams working together. The programs are not just focused upon red cells but also on coagulation therapy. Coagulopathy is at times a difficult complex pathologic conundrum. In cardiac surgery the complexity is added to because of the inflammatory effects of anticoagulation, air/blood interfaces, and inflammation. Patients respond variably due to their own genetic and environmental factors. There can be a rational approach, thereby avoiding panic (a normal fear response) if the clinician utilizes not only the available laboratory technologies existing today but also follows published algorithms for treatment. These technologies with their coexisting algorithms have been widely shown to decrease blood usage, yet not to decrease bleeding. That finding suggests that therapy without such guidance wastes expensive pro-coagulant blood products and produces no advantage (a decrease in bleeding). When a therapy produces no advantage all that it leaves the patient with is the side effects or adverse outcomes. Adverse outcomes from coagulation products are real and sobering.

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Section: Heparin Anticoagulationmentioning

confidence: 99%

Blood Management—Issues: The Panic of Coagulopathic Bleeding—Is There a Rational Approach?

Spiess

2011

J Extra Corpor Technol

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“…23 Variable blood usage in cardiac surgery persists. 21,22 Consensus guidelines for POC VET (level 1-B) have not been adopted. 23,24,25,26 Wide QI is possible for cardiac care if PBM principles were to be standard.…”

Section: Introductionmentioning

confidence: 99%

“…1,11-17,18,19, Unguided fresh frozen plasma (FFP) and platelet (Plt) transfusions are directly related to TRALI, stroke, and death (6-10% increased mortality/unit). [18][19][20][21][22] Unguided use of pro-coagulant pharmaceuticals create hypercoagulability, thrombosis and increased cost. 23 Variable blood usage in cardiac surgery persists.…”

Section: Introductionmentioning

confidence: 99%

A Cohort, Semi-Randomized, Open Label Quality Improvement Patient Blood Management (PBM) Comparison of Point of Care Viscoelastic Coagulation Monitors in Cardiac Surgery

Spiess,

Burger,

Michael

et al. 2024

Preprint

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Purpose: Viscoelastic testing (VET), recommended for heart surgery, has not been adopted due to lack of timely point of care (POC) technology. Several POC VET devices have become available. The purposes of this quality initiative (QI), part of a patient blood management program-PBM), were to: 1) Compare two POC VET for timeliness 2) Survey need, ease of use, acceptability, and set up for the on-going PBM program. Methods: The TEG-6s and the Quantra Q-plus Hemostasis Analyzer, were assessed in cardiac patients (n = 68) over a six-week period (May 15 -June 30, 2021). Timeliness of data acquisition was analyzed. Algorithms to assist physicians in therapeutic interventions were created. Cardiac members answered quality assessment surveys. Impacts on blood ordering were analyzed compared to a corresponding 6-week period pre COVID-19 epidemic. Results: Prior to the QI initiative, respondents noted time problems for laboratory coagulation analysis and acquisition of blood products. TEG 6s reporting time was 24.9 +/-4 minutes. Quantra Qplus required 49% less time, 12.9 +/- 1.3 minutes (P<0.0001). No differences in transfusion were seen. The use of POC VET reduced blood products ordered, unused, returned to the blood bank. Conclusions: We describe head-to-head testing prior to implementation as the next step in PBM QI. Quantra Qplus was twice as fast. Clinicians preferred the speed, ease of use, and interpretability of the Quantra. Large studies are needed to investigate the PBM benefit of POC VET.

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Thrombography Reveals Thrombin Generation Potential Continues to Deteriorate Following Cardiopulmonary Bypass Surgery Despite Adequate Hemostasis

Wong¹,

Sleep²,

Visner³

et al. 2011

J Extra Corpor Technol

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The intrinsic and extrinsic activation pathways of the hemostatic system converge when prothrombin is converted to thrombin. The ability to generate an adequate thrombin burst is the most central aspect of the coagulation cascade. The thrombin-generating potential in patients following cardiopulmonary bypass (CPB) may be indicative of their hemostatic status. In this report, thrombography, a unique technique for directly measuring the potential of patients’ blood samples to generate adequate thrombin bursts, is used to characterize the coagulopathic profile in post-CPB patients. Post-CPB hemostasis is typically achieved with protamine reversal of heparin anticoagulation and occasionally supplemented with blood product component transfusions. In this pilot study, platelet poor plasma samples were derived from 11 primary cardiac surgery patients at five time points: prior to CPB, immediately post-protamine, upon arrival to the intensive care unit (ICU), 3 hours post-ICU admission, and 24 hours after ICU arrival. Thrombography revealed that the Endogenous Thrombin Potential (ETP) was not different between [Baseline] and [PostProtamine] but proceeded to deteriorate in the immediate postoperative period. At the [3HourPostICU] time point, the ETP was significantly lower than the [Baseline] values, 1233 ± 591 versus 595 ± 379 nM.min (mean ± SD; n = 9, p < .005), despite continued adequacy of hemostasis. ETPs returned to baseline values the day after surgery. Transfusions received, conventional blood coagulation testing results, and blood loss volumes are also presented. Despite adequate hemostasis, thrombography reveals an underlying coagulopathic process that could put some cardiac surgical patients at risk for postoperative bleeding. Thrombography is a novel technique that could be developed into a useful tool for perfusionists and physicians to identify coagulopathies and optimize blood management following CPB.

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Un petit peu de connaissances sur la coagulation peut s’avérer dangereux!

Cited by 3 publications

References 14 publications

Blood Management—Issues: The Panic of Coagulopathic Bleeding—Is There a Rational Approach?

Blood Management—Issues: The Panic of Coagulopathic Bleeding—Is There a Rational Approach?

A Cohort, Semi-Randomized, Open Label Quality Improvement Patient Blood Management (PBM) Comparison of Point of Care Viscoelastic Coagulation Monitors in Cardiac Surgery

Thrombography Reveals Thrombin Generation Potential Continues to Deteriorate Following Cardiopulmonary Bypass Surgery Despite Adequate Hemostasis

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