Universal definition of perioperative bleeding in adult cardiac surgery

Abstract

The proposed UDPB in adult cardiac surgery provides a precise classification of bleeding that is useful in everyday practice as well as in clinical research. Once fully validated, the UDPB may be useful as an institutional quality measure and serve as an important end point in future cardiac surgical research.

Outcome measures and quality markers for perioperative blood loss and transfusion in cardiac surgery

“…11,12 In 2014, a consortium of clinicians, including cardiac surgeons, cardiac anesthesiologists, and pharmacoeconomists, attempted to address the problem of defining and grading perioperative bleeding in adult cardiac surgery. 13 The universal definition for perioperative bleeding (UDPB) that they proposed is based on nine items: delayed sternal closure; chest drain blood loss; amount of RBCs transfused; use of any FFP, PLT, cryoprecipitates, prothrombin complex concentrates, recombinant activated factor VII; and presence of surgical revision/re-exploration. Based on these factors, the bleeding can be defined as insignificant, mild, moderate, severe, or massive.…”

Preoperative Prasugrel Discontinuation Management in Coronary Artery Surgery

“…Initiative for Hemostasis in Cardiac Surgery recently proposed universal, multistage definition of perioperative bleeding in cardiac surgery [2]. This definition presents composite endpoint that is consisted of all variables relevant for assessment of bleeding outcome and provides grading of bleeding severity [2].…”

“…This definition presents composite endpoint that is consisted of all variables relevant for assessment of bleeding outcome and provides grading of bleeding severity [2]. In our opinion, this definition should be used for further similar studies as does provide the most reliable estimation of the relationship between preoperative exposure to different antiplatelet drugs and occurrence of mild, moderate, severe and massive bleeding, respectively [2].…”

“…This definition presents composite endpoint that is consisted of all variables relevant for assessment of bleeding outcome and provides grading of bleeding severity [2]. In our opinion, this definition should be used for further similar studies as does provide the most reliable estimation of the relationship between preoperative exposure to different antiplatelet drugs and occurrence of mild, moderate, severe and massive bleeding, respectively [2]. Hypothetically, using this approach, further studies could provide better understanding of the possible risks of bleeding inherent to antiplatelet drugs, and expected severity of bleeding which in turn could advise preferred preoperative antiplatelet discontinuation management as well as timing of surgery.…”

“…Further studies evaluating the relationship between preoperative antiplatelet therapy management and bleeding outcomes should use standardized way in defining clinical endpoints [2] and should inevitably include drug specific platelet function testing as it may provide better understanding on the platelet inhibitory effect of the drugs and dynamics of platelets recovery after drugs discontinuation.…”