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Morinaga M, Yoshitani K, Ogata S, Fukushima S, Matsuda H. Association between intraoperative blood salvage and coagulation disorder after cardiopulmonary bypass. JA Clin Rep 2024; 10:5. [PMID: 38270666 PMCID: PMC10810763 DOI: 10.1186/s40981-024-00689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND This study investigated whether intraoperative blood salvage was associated with coagulation disorder diagnosed by conventional coagulation tests and thromboelastography (TEG) after cardiopulmonary bypass (CPB). STUDY DESIGN AND METHODS This was a prospective, observational study. Ninety-two patients who underwent cardiovascular surgery with CPB were enrolled. We evaluated coagulation function in patients with or without cell salvage blood transfusion at the following time points: before CPB, just after protamine administration, and 1 h after protamine administration. We evaluated platelet count, fibrinogen concentration, and TEG parameters. Patients were considered to have coagulation disorder if one or more of the following criteria were present: (1) residual heparin, (2) low platelet count, (3) low fibrinogen level, (4) low clotting factor level, and (5) hyperfibrinolysis. RESULTS Fifty-three of 92 patients (57.6%) received intraoperative cell salvage. Coagulation disorder was observed in 56 of 92 patients (60.9%) after CPB. There was no significant difference between patients with or without intraoperative blood salvage in terms of the incidence of coagulation disorder (p = 0.542) or the total volume of blood from the drain after CPB (p = 0.437). Intraoperative blood salvage was not associated with coagulation disorder diagnosed by either TEG or conventional coagulation tests (odds ratio 1.329, 95% confidence interval: 0.549-3.213, p = 0.547). There were no significant interactions between patients with or without intraoperative blood salvage regarding coagulation parameters derived from TEG. CONCLUSIONS The incidence of coagulation disorder and the total blood volume from the drain after CPB did not differ significantly between patients with or without intraoperative blood salvage.
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Affiliation(s)
- Masahiro Morinaga
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Stoneham MD, Barbosa A, Maher K, Douglass P, Desborough MJR, Von Kier S. Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss. Br J Haematol 2023; 200:652-659. [PMID: 36253085 DOI: 10.1111/bjh.18523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022]
Abstract
The loss of 50% blood volume is one accepted definition of massive haemorrhage, which ordinarily would trigger the massive transfusion protocol, involving the administration of high ratios of fresh frozen plasma and platelets to allogeneic red cells. We investigated 53 patients who experienced >50% blood loss during open elective abdominal aortic aneurysm surgery to assess allogeneic blood component usage and coagulopathy. Specialist patient blood management practitioners used a tailored cell salvage technique including swab wash to maximise blood return. We assessed the proportion of patients who did not require allogeneic blood components and develop evidence of coagulopathy by thromboelastography (TEG) parameters. Blood loss was 50%-174% (mean [SD] 68% [27%]) of blood volume. The mean (SD) intraoperative decrease in haemoglobin concentration, assessed by arterial blood gas analysis, was 5 (13) g/l. No patient received allogeneic red cells intraoperatively. Four of the 53 (8%) patients received blood components in the first 24 h postoperatively at the anaesthetists' discretion. No patient had intraoperative TEG changes indicative of fibrinolysis or coagulopathy. The 30-day mortality was 2% (one of 53). Reduction of allogeneic transfusion is one aim of patient blood management techniques. We have demonstrated virtual avoidance of allogeneic blood product transfusion despite massive blood loss. These data show possible alternatives to the current massive transfusion protocols to the management of elective vascular surgical patients.
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Affiliation(s)
- Mark D Stoneham
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonio Barbosa
- Haemostasis and Blood Conservation Service, John Radcliffe Hospital, Oxford, Oxon, UK
| | - Keith Maher
- Haemostasis and Blood Conservation Service, John Radcliffe Hospital, Oxford, Oxon, UK
| | - Paul Douglass
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael J R Desborough
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Steve Von Kier
- Haemostasis and Blood Conservation Service, John Radcliffe Hospital, Oxford, Oxon, UK
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Gyi R, Cho BC, Hensley NB. Patient Blood Management in Vascular Surgery. Anesthesiol Clin 2022; 40:605-625. [PMID: 36328618 DOI: 10.1016/j.anclin.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Patient blood management (PBM) is an evidence-based, multidisciplinary approach aimed at appropriately allocating blood products to patients requiring transfusion while simultaneously minimizing inappropriate transfusions. The 3 pillars of patient blood management are optimizing erythropoiesis, minimizing blood loss, and optimizing physiological reserve of anemia. Benefits seen from PBM include limiting hospital costs and mitigating harm from numerous risks of transfusion.
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Affiliation(s)
- Richard Gyi
- Department of Anesthesiology, Johns Hopkins Hospital, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA
| | - Brian C Cho
- Department of Anesthesiology, Johns Hopkins Hospital, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA; Division of Cardiothoracic Anesthesiology, Johns Hopkins University School of Medicine, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA
| | - Nadia B Hensley
- Division of Cardiothoracic Anesthesiology, Johns Hopkins University School of Medicine, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA.
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Patel PA, Henderson RA, Bolliger D, Erdoes G, Mazzeffi MA. The Year in Coagulation: Selected Highlights from 2020. J Cardiothorac Vasc Anesth 2021; 35:2260-2272. [PMID: 33781668 DOI: 10.1053/j.jvca.2021.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/28/2023]
Abstract
This is the second annual review in the Journal of Cardiothoracic and Vascular Anesthesia to cover highlights in coagulation for cardiac surgery. The goal of this article is to provide readers with a focused summary from the literature of the prior year's most important coagulation topics. In 2020, this included a discussion covering allogeneic transfusion, antiplatelet and anticoagulant therapy, factor concentrates, coagulation testing, mechanical circulatory support, and the effects of coronavirus disease 2019.
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Affiliation(s)
- Prakash A Patel
- Department of Anesthesiology, Cardiothoracic Division, Yale University School of Medicine, New Haven, CT.
| | - Reney A Henderson
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel Bolliger
- Department of Anesthesiology, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Michael A Mazzeffi
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Maryland School of Medicine, Baltimore, MD; Department of Anesthesiology, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
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5
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Hartinger JM, Svobodová A, Malíková I, Šachl R, Slanař O. Effective use of fondaparinux in patient with unresponsiveness to nadroparin. J Clin Pharm Ther 2020; 46:539-542. [PMID: 33277918 DOI: 10.1111/jcpt.13328] [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] [Received: 09/18/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Fondaparinux exhibits a similar mechanism of action as LMWH. Since both of these drugs bind to antithrombin and increase its affinity to factor Xa, fondaparinux is not expected to be an effective alternative anticoagulant to LMWH in case of LMWH resistance. CASE SUMMARY We report on a case of effective anticoagulation using fondaparinux following total unresponsiveness to high doses of nadroparin administered twice daily, as confirmed via repeated anti-Xa measurements. The antithrombin levels were within the normal range. WHAT IS NEW AND CONCLUSION To the best of our knowledge, this is the first report of the effective use of fondaparinux in the case of unresponsiveness to LMWH.
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Affiliation(s)
- Jan Miroslav Hartinger
- Department of Clinical Pharmacology and Pharmacy, Institute of Pharmacology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Alžběta Svobodová
- II. Surgical Clinic - Cardiovascular Surgery, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ivana Malíková
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Robert Šachl
- Department of Anesthesiology and Intensive Care, Institute of Pharmacology, 1st Faculty of Medicine and Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ondřej Slanař
- Department of Clinical Pharmacology and Pharmacy, Institute of Pharmacology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Bolliger D, Tanaka KA. More Is Not Always Better: Effects of Cell Salvage in Cardiac Surgery on Postoperative Fibrinogen Concentrations. J Cardiothorac Vasc Anesth 2020; 34:2383-2385. [DOI: 10.1053/j.jvca.2020.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 12/25/2022]
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Merkel KR, Lin SD, Frank SM, Kajstura TJ, Cruz NC, Lo BD, Black JH, Gehrie EA, Hensley NB, Cho BC, Lester LC. Balancing the Blood Component Transfusion Ratio for High- and Ultra High-Dose Cell Salvage Cases. J Cardiothorac Vasc Anesth 2020; 35:1060-1066. [PMID: 32928652 DOI: 10.1053/j.jvca.2020.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the ratio of non-red blood cell to red blood cell components required to avoid coagulopathy when transfusing large amounts of salvaged blood using laboratory test-guided therapy. DESIGN Retrospective cohort study. SETTING Single-center, academic hospital. PARTICIPANTS Thoracoabdominal and abdominal open aortic surgery patients. MEASUREMENT AND MAIN RESULTS Thirty-eight patients in whom at least 1,000 mL of salvaged red blood cells were transfused were identified and divided into the following 2 cohorts: 1,000-to-2,000 mL of salvaged red blood cells (high dose) (n = 20) and >2,000 mL of salvaged red blood cells (ultra-high dose) (n = 18). Compared with the high-dose cohort, the ultra high-dose cohort received ∼4 times more salvaged red blood cells (1,240 ± 279 mL v 5,550 ± 3,801 mL). With transfusion therapy guided by intraoperative coagulation tests and thromboelastography, the adjusted ratio of non-red blood cell to red blood cell components (plasma + platelets + cryoprecipitate:allogeneic + salvaged red blood cells) was 0.59 ± 0.66 in the high-dose and 0.93 ± 0.27 in the ultra high-dose cohorts. Multiple coagulation parameters were normal and similar between cohorts at the end of surgery, as determined by the mean, median, and 95% confidence intervals. CONCLUSIONS When transfusing large volumes of salvaged blood, it is important to balance the ratio between non-red blood cell and red blood cell components. Through a laboratory test-guided approach, coagulopathy was not detected when transfusing blood in ratios of approximately 1:2 for patients receiving 1,000-to-2,000 mL of salvaged blood and 1:1 for patients receiving >2,000 mL of salvaged blood.
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Affiliation(s)
- Kevin R Merkel
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Sophia D Lin
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Tymoteusz J Kajstura
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nicolas C Cruz
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brian D Lo
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - James H Black
- Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Eric A Gehrie
- Departments of Pathology (Transfusion Medicine) and Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nadia B Hensley
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brian C Cho
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Laeben C Lester
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
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Adam EH, Funke M, Zacharowski K, Meybohm P, Keller H, Weber CF. Impact of Intraoperative Cell Salvage on Blood Coagulation Factor Concentrations in Patients Undergoing Cardiac Surgery. Anesth Analg 2020; 130:1389-1395. [DOI: 10.1213/ane.0000000000004693] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Impact of drugs on venous thromboembolism risk in surgical patients. Eur J Clin Pharmacol 2019; 75:751-767. [DOI: 10.1007/s00228-019-02636-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/21/2019] [Indexed: 01/14/2023]
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10
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Puvanesarajah V, Rao SS, Hassanzadeh H, Kebaish KM. Determinants of perioperative transfusion risk in patients with adult spinal deformity. J Neurosurg Spine 2018; 28:429-435. [DOI: 10.3171/2017.10.spine17884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVETo determine predictors of perioperative allogeneic packed red blood cell (pRBC) transfusion requirement (total units transfused) in patients with adult spinal deformity (ASD).METHODSThe authors retrospectively analyzed records of patients aged 18 years or older who underwent surgical correction of ASD that involved 4 or more spinal levels by the same spine surgeon between 2010 and 2016. Data regarding patient characteristics, comorbidities, surgical factors, and perioperative transfusions (up to 10 days after surgery) were analyzed using a linear regression model. Significance was set at p < 0.05.RESULTSThe authors analyzed 165 patients (118 women) with a mean (± SD) age of 61 ± 12 years. Three-column osteotomies were associated with a mean intraoperative transfusion volume of 1.74 additional units of pRBCs. Each unit of intraoperatively salvaged blood used was associated with a mean 0.39-U increase in postoperative transfusion volume (p = 0.031). Every unit of allogeneic blood transfused intraoperatively was associated with a mean 0.23-U decrease in postoperative transfusion volume (p = 0.001). A preoperative hemoglobin concentration of 11.5 g/dl or more was associated with significantly fewer units transfused intraoperatively; a preoperative hemoglobin concentration of 14.0 g/dl or more was associated with fewer units transfused postoperatively. A history of smoking and intraoperative antifibrinolytic use were associated with increased and decreased numbers of units transfused postoperatively, respectively.CONCLUSIONSEffective blood management is key to perioperative care of patients with ASD. Three-column osteotomies were associated with a greater number of units of blood transfused. When considering postoperative transfusion requirements, surgeons should note that intraoperative blood salvage might be inferior to intraoperative allogeneic blood transfusion. Using antifibrinolytics and increasing the preoperative hemoglobin concentration to 11.5 g/dl or more are strategies for decreasing the need for perioperative transfusion. A history of smoking is a risk factor for postoperative transfusion requirement (total units transfused).
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Affiliation(s)
- Varun Puvanesarajah
- 1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; and
| | - Sandesh S. Rao
- 1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; and
| | - Hamid Hassanzadeh
- 2Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Khaled M. Kebaish
- 1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; and
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11
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Autologous and Nonautologous Blood Transfusion in Patients with Ruptured Ectopic Pregnancy and Severe Blood Loss. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7501807. [PMID: 28695130 PMCID: PMC5488227 DOI: 10.1155/2017/7501807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are some theoretical concerns for the use of intraoperative cell salvage (ICS) in patients with ectopic pregnancy. This study aimed to observe the impact of ICS on the coagulation function and clinical outcomes of patients with ruptured ectopic pregnancy and severe blood loss. METHODS This was a retrospective study of 225 patients with ruptured ectopic pregnancy and severe blood loss treated at the Third Affiliated Hospital of Guangxi Medical University between January 2012 and May 2016. Patients were grouped according to ICS (n = 116) and controls (n = 109, allogenic transfusion and no transfusion). RESULTS Compared with controls, patients with ICS had shorter hospitalization (P = 0.007), lower requirement for allogenic blood products (P < 0.001), and higher hemoglobin levels at discharge (P < 0.001). There were no complications/ adverse reactions. In the ICS group, hemoglobin at discharge (-6.5%, P = 0.002) and thrombin time (-3.7%, P = 0.002) were decreased 24 h after surgery, while 24 h APTT was increased (+4.6%, P < 0.001). In the control group, hemoglobin at discharge (-16.8%, P < 0.001) was decreased after surgery and 24 h APTT was increased (+2.4%, P = 0.045). At discharge, hemoglobin levels were higher in the ICS group (P < 0.001). CONCLUSION ICS was associated with good clinical outcomes in patients with ruptured ectopic pregnancy and severe blood loss.
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12
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Sikorski RA, Rizkalla NA, Yang WW, Frank SM. Autologous blood salvage in the era of patient blood management. Vox Sang 2017; 112:499-510. [DOI: 10.1111/vox.12527] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/01/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- R. A. Sikorski
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore MA USA
| | - N. A. Rizkalla
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore MA USA
| | - W. W. Yang
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore MA USA
| | - S. M. Frank
- Department of Anesthesiology/Critical Care Medicine; Johns Hopkins Health System Blood Management Program; The Johns Hopkins Medical Institutions; MA USA
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Shen S, Zhang J, Wang W, Zheng J, Xie Y. Impact of intra-operative cell salvage on blood coagulation in high-bleeding-risk patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial. J Transl Med 2016; 14:228. [PMID: 27473326 PMCID: PMC4966771 DOI: 10.1186/s12967-016-0986-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/20/2016] [Indexed: 02/06/2023] Open
Abstract
Background Intra-operative cell salvage (CS) was reported to have no impairment on blood coagulation in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the impact of CS on blood coagulation in high-bleeding-risk cardiac surgery with CPB. Methods One hundred and ten patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints included the incidence of impairment of blood coagulation during perioperative period (peri-op) and the incidence of adverse events during postoperative period (post-op). Peri-op was defined as the period from beginning of anesthesia (anesthesia induction) to 24 h after end of surgery. Post-op was defined as the period from the end of surgery to 24 h after end of surgery. The types of impairment of blood coagulation included heparin residual, coagulopathy due to low PLT, coagulopathy due to low FIB, coagulopathy due to low coagulation factors, hyperfibrinolytic. The sum of above five types was total impairment of blood coagulation. Adverse events included excessive bleeding, resternotomy, etc. Results The incidence of heparin residual measured both at the end of surgery and during post-op were significantly higher in Group CS than in Group C (15.09 vs 4.00, 13.21 vs 2.00 %; p = 0.024, 0.010, respectively). Similarly, the incidence of total impairment of blood coagulation at the end of surgery and during post-op were significantly higher in Group CS than in Group C (32.08 vs 18.00, 26.42 vs 12.00 %; p = 0.043, 0.040, respectively). The incidence of excessive bleeding during post-op was 32.08 % in Group CS compared with 16.00 % in Group C (p = 0.038). Intriguingly, CS was associated with a significantly increase in the relative risk ratios for heparin residual and excessive bleeding (p = 0.034, 0.049, respectively). Conclusions Intra-operative CS could impair blood coagulation in the scenario of high-risk-bleeding cardiac surgery with CPB.
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Affiliation(s)
- Sheliang Shen
- Department of Anesthesiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Wenyuan Wang
- Department of Anesthesiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jiayin Zheng
- Department of Probability and Statistics, School of Mathematical Sciences, Beijing University, Beijing, China
| | - Yihong Xie
- Department of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
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14
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Discriminatory power of the intraoperative cell salvage use in the prediction of platelet and plasma transfusion in patients undergoing cardiac surgery. Transfus Apher Sci 2015; 53:208-12. [DOI: 10.1016/j.transci.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/20/2022]
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15
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Zheng J, Du L, Du G, Liu B. Coagulopathy associated with cell salvage transfusion following cerebrovascular surgery. Pak J Med Sci 2013; 29:1459-61. [PMID: 24550976 PMCID: PMC3905379 DOI: 10.12669/pjms.296.3750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 02/05/2023] Open
Abstract
A 35-year-old man was scheduled for dural arteriovenous fistula resection for vascular malformation under general anesthesia and a cell saver device was employed. The patient suffered from massive bleeding for the rupture of arteriovenous malformations from the beginning of the operation and 1000 mL cell-saved blood was transfused. After autologous blood transfusion and fluid resuscitation, blood oozed significantly from the surgical wounds, and the administration of cryoprecipitate and fibrinogen has no effect. The value of the activated coagulation time (ACT) increased to 999s. Considering the residual heparin in the autologous blood, ninety mg of protamine was intravenously injected, then 5 minutes later the ACT dropped to 147s. After the therapy, the surgical procedure was performed smoothly. The activated partial thromboplastin time (APTT) and the thrombin time (TT) of the postoperative venous blood was 18.9 s and 53.6 s respectively. Two days later, the APTT and the TT decreased to 12.1 s and 32.7 s without special treatment. The patient was discharged home without complications and well follow-up.
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Affiliation(s)
- Jianqiao Zheng
- Jianqiao Zheng, MD, Department of Anesthesiology, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu 610041, Sichuan, China
| | - Li Du
- Li Du, MD, Department of Anesthesiology, Sichuan Cancer Hospital, No.55, People's South Road, Chengdu 610041, Sichuan, China
| | - Guizhi Du
- Guizhi Du, MD, Department of Anesthesiology, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu 610041, Sichuan, China
| | - Bin Liu
- Bin Liu, MD, PhD, Department of Anesthesiology, West China Hospital of Sichuan University, No. 37, Guo Xue Alley, Chengdu 610041, Sichuan, China
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