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Jooste EH, Machovec KA, Einhorn LM, Ames WA, Homi HM, Jaquiss RDB, Lodge AJ, Levy JH, Welsby IJ. 3-Factor Prothrombin Complex Concentrates in Infants With Refractory Bleeding After Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:1627-1631. [PMID: 27236492 DOI: 10.1053/j.jvca.2016.01.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Edmund H Jooste
- Department of Anesthesiology, Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, NC.
| | - Kelly A Machovec
- Department of Anesthesiology, Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, NC
| | - Lisa M Einhorn
- Department of Anesthesiology, Duke University, Durham, NC
| | - Warwick A Ames
- Department of Anesthesiology, Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, NC
| | - Hercilia M Homi
- Department of Anesthesiology, Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, NC
| | - Robert D B Jaquiss
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, NC
| | - Andrew J Lodge
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke Children's Pediatric and Congenital Heart Center, Duke University, Durham, NC
| | - Jerrold H Levy
- Department of Anesthesiology, Division of Adult Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, NC
| | - Ian J Welsby
- Department of Anesthesiology, Division of Adult Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, NC
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Mujib M, Khanna N, Mazumder NK, Aronow WS, Kolte D, Khera S, Palaniswamy C, Jain D, Lanier GM, Sule S, Ahmed A, Levy WC, Prabhu SD, Cooper HA, Panza JA, Gass AL, Fonarow GC. Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study. Clin Cardiol 2015; 38:300-8. [PMID: 25684174 DOI: 10.1002/clc.22391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. HYPOTHESIS Pre-HT coagulopathy is associated with increased in-hospital mortality. METHODS Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. RESULTS The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). CONCLUSIONS In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
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Affiliation(s)
- Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Neel Khanna
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Nabila K Mazumder
- Department of Medicine, Flushing Hospital Medical Center, Flushing, New York
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg M Lanier
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Ali Ahmed
- Department of Medicine, Washington DC VA Medical Center, Washington, DC
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Alan L Gass
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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5
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Thiele RH, Raphael J. A 2014 Update on Coagulation Management for Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth 2014; 18:177-89. [DOI: 10.1177/1089253214534782] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Coagulopathy after cardiac surgery with cardiopulmonary bypass is a serious complication that may result in massive bleeding requiring transfusion of significant amounts of blood products, plasma, and platelets. In addition to increased patient morbidity and mortality it is associated with longer hospital stay and increased resource utilization. The current review discusses aspects in cardiopulmonary bypass–induced coagulopathy with emphasis on point-of-care testing and individualized “goal-directed” therapy in patients who develop excessive bleeding after cardiac surgery.
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Affiliation(s)
| | - Jacob Raphael
- University of Virginia Health System, Charlottesville, VA, USA
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6
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Motshabi Chakane P. Blood is thicker than water: coagulation challenges in the perioperative period. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2014.10844567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- P Motshabi Chakane
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg
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8
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Stéphan F. [Managing of excessive bleeding after cardiac surgery under cardiopulmonary bypass]. Transfus Clin Biol 2012; 19:159-64. [PMID: 23039953 DOI: 10.1016/j.tracli.2012.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 07/21/2012] [Indexed: 11/19/2022]
Abstract
The occurrence of abnormal bleeding in postoperative cardiac surgery performed under cardiopulmonary bypass is relatively common. If the option of reoperation is not retained, the initiation of medical treatment is inevitable. Next to the transfusion of blood products, other therapies were often used empirically and as "off-label". The place of each in a future regimen should be based on well-conducted clinical studies to determine the optimal risk/benefit ratio.
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Affiliation(s)
- F Stéphan
- Réanimation adulte, centre chirurgical Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis Robinson, France.
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