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Williams B, Henderson R, Mazzeffi M, Tanaka K. FEIBA: Too Potent a Potion or Just Right for Post-CPB Bleeding? J Cardiothorac Vasc Anesth 2024; 38:1882-1884. [PMID: 38972817 DOI: 10.1053/j.jvca.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Brittney Williams
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Reney Henderson
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Kenichi Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Wise-Faberowski L, Irvin M, Quinonez ZA, Long J, Asija R, Margetson TD, Hanley FL, McElhinney DB. Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals. World J Pediatr Congenit Heart Surg 2020; 11:159-165. [PMID: 32093560 DOI: 10.1177/2150135119892192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical repair of tetralogy of Fallot and major aortopulmonary collaterals (TOF/MAPCAs) involves unifocalization of MAPCAs and reconstruction of the pulmonary arterial circulation. Surgical and cardiopulmonary bypass (CPB) times are long and suture lines are extensive. Maintaining patency of the newly anastomosed vessels while achieving hemostasis is important, and assessment of transfusion practices is critical to successful outcomes. METHODS Clinical, surgical, and transfusion data in patients with TOF/MAPCAs repaired at our institution (2013-2018) were reviewed. Types and volumes of blood products used in the perioperative period, in addition to the use of antifibrinolytics and/or procoagulants (factor VIII inhibitor bypassing activity [FEIBA]; anti-inhibitor coagulant complex), were assessed. Outcome measures included days on mechanical ventilation (DOMV), postoperative intensive care unit and hospital length of stay (LoS), and incidence of thrombosis. RESULTS Perioperative transfusion data from 279 patients were analyzed. Surgical (879 ± 175 minutes vs 684 ± 257 minutes) and CPB times (376 ± 124 minutes vs 234 ± 122 minutes) were longer in patients who received FEIBA than those who did not. Although the indexed volume of packed red blood cells (128.4 ± 82.2 mL/kg) and fresh frozen plasma (64.2 ± 41.1 mL/kg) was similar in patients who did and did not receive FEIBA, the amounts of cryoprecipitate (5.5 ± 5.2 mL/kg vs 5.8 ± 4.8 mL/kg) and platelets (19.5 ± 20.7 mL/kg vs 20.8 ± 13 mL/kg) transfused were more in those who did receive FEIBA. CONCLUSION Perioperative transfusion is an important component in the overall surgical and anesthetic management of patients with TOF/MAPCAs. The intraoperative use of FEIBA was not associated with a decrease in the amount of blood products transfused, DOMV, or LoS or with an increase in thrombotic complications.
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Affiliation(s)
- Lisa Wise-Faberowski
- Department of Anesthesiology, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Matthew Irvin
- Clinical and Translational Research Program, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Zoel A Quinonez
- Department of Anesthesiology, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Jin Long
- Quantitative Sciences Unit, Department of Medicine, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Tristan D Margetson
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
| | - Doff B McElhinney
- Clinical and Translational Research Program, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA.,Department of Pediatrics, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA.,Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center, Stanford University, Stanford, CA, USA
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Carroll RB, Zaki H, McCracken C, Figueroa J, Guzzetta NA. Use of Factor VIIa and Anti-inhibitor Coagulant Complex in Pediatric Cardiac Surgery Patients. J Pediatr Pharmacol Ther 2020; 25:540-546. [PMID: 32839658 DOI: 10.5863/1551-6776-25.6.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Postoperative bleeding is a common cause of morbidity and mortality in cardiac patients who undergo cardiopulmonary bypass (CPB). Pediatric patients are especially at risk for adverse effects of surgery and CPB on the coagulation system. This can result in bleeding, transfusions, and poor outcomes. Excessive bleeding unresponsive to blood products can warrant the off-label use of recombinant activated clotting factor VIIa (rFVIIa) and/or anti-inhibitor coagulant complex (FEIBA). Several studies have shown the utility in these agents off-label in patients who have undergone cardiac bypass surgery with acute bleeding episodes that are refractory to blood products. However, data regarding use of these agents in pediatrics are sparse. The purpose of this study is to report the use of rFVIIa and FEIBA in pediatric cardiac surgery patients in our institution. METHODS This was a retrospective chart review of pediatric cardiothoracic surgery patients who received rFVIIa or FEIBA at Children's Healthcare of Atlanta during the study period. RESULTS Thirty-three patients received rFVIIa and 9 patients received FEIBA either intraoperatively or postoperatively for bleeding related to the cardiac procedure. Approximately 13% of rFVIIa patients and 55% of FEIBA patients required repeat doses. There were decreases for all blood products administered after rFVIIa and FEIBA were given. However, the doses used did not correlate with either positive or negative outcomes. Seventeen percent (n = 7) of rFVIIa patients experienced a thrombus and 22% (n = 2) of FEIBA patients experienced a thrombus. CONCLUSIONS Both rFVIIa and FEIBA reduced blood product usage in pediatric patients following cardiac procedures.
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Williams B, Wehman B, Mazzeffi MA, Odonkor P, Harris RL, Kon Z, Tanaka KA. Acute Intracardiac Thrombosis and Pulmonary Thromboembolism After Cardiopulmonary Bypass. Anesth Analg 2018; 126:425-434. [DOI: 10.1213/ane.0000000000002259] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Smith MM, Ashikhmina E, Brinkman NJ, Barbara DW. Perioperative Use of Coagulation Factor Concentrates in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:1810-1819. [DOI: 10.1053/j.jvca.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 11/11/2022]
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Rao VK, Lobato RL, Bartlett B, Klanjac M, Mora-Mangano CT, David Soran P, Oakes DA, Hill CC, van der Starre PJ. Factor VIII Inhibitor Bypass Activity and Recombinant Activated Factor VII in Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:1221-6. [DOI: 10.1053/j.jvca.2014.04.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Indexed: 11/11/2022]
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