1
|
Mazzeffi M, Beller J, Strobel R, Norman A, Wisniewski A, Smith J, Fonner CE, McNeil J, Speir A, Singh R, Tang D, Quader M, Yarboro L, Teman N. Trends in the Use of Recombinant Activated Factor VII and Prothrombin Complex Concentrate in Heart Transplant Patients in Virginia. J Cardiothorac Vasc Anesth 2024; 38:660-666. [PMID: 38220518 DOI: 10.1053/j.jvca.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES To explore trends in intraoperative procoagulant factor concentrate use in patients undergoing heart transplantation (HTx) in Virginia. Secondarily, to evaluate their association with postoperative thrombosis. DESIGN Patients who underwent HTx were identified using a statewide database. Trends in off-label recombinant activated factor VII (rFVIIa) use and on-label and off-label prothrombin complex concentrate (PCC) use were tested using the Mantel-Haenszel test. Multivariate logistic regression was used to test for an association between procoagulant factor concentrate administration and thrombosis. SETTING Virginia hospitals performing HTx. PARTICIPANTS Adults undergoing HTx between 2012 and 2022. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 899 patients who required HTx, 100 (11.1%) received off-label rFVIIa, 69 (7.7%) received on-label PCC, and 80 (8.9%) received off-label PCC. There was a downward trend in the use of rFVIIa over the 10-year period (p = 0.04). There was no trend in on-label PCC use (p = 0.12); however, there was an increase in off-label PCC use (p < 0.001). Patients who received rFVIIa were transfused more and had longer cardiopulmonary bypass time (p < 0.001). Receipt of rFVIIa was associated with increased thrombotic risk (odds ratio [OR] 1.92; 95% CI 1.12-3.29; p = 0.02), whereas on-label and off-label PCC use had no association with thrombosis (OR 0.98, 95% CI 0.49-1.96, p = 0.96 for on-label use; and OR 0.61, 95% CI 0.29-1.30, p = 0.20 for off-label use). CONCLUSIONS Use of rFVIIa in HTx decreased over the past decade, whereas off-label PCC use increased. Receipt of rFVIIa was associated with thrombosis; however, patients who received rFVIIa were more severely ill, and risk adjustment may have been incomplete.
Collapse
Affiliation(s)
- Michael Mazzeffi
- University of Virginia, Department of Anesthesiology, Charlottesville, VA.
| | - Jared Beller
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Raymond Strobel
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Anthony Norman
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Alexander Wisniewski
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Judy Smith
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | | | - John McNeil
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Alan Speir
- INOVA Heart and Vascular Institute, Department of Cardiothoracic Surgery, Fairfax, VA
| | - Ramesh Singh
- INOVA Heart and Vascular Institute, Department of Cardiothoracic Surgery, Fairfax, VA
| | - Daniel Tang
- INOVA Heart and Vascular Institute, Department of Cardiothoracic Surgery, Fairfax, VA
| | - Mohammed Quader
- Virginia Commonwealth University, Department of Surgery, Division of Cardiothoracic Surgery, Richmond, VA
| | - Leora Yarboro
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Nicholas Teman
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| |
Collapse
|
2
|
Nesseler N, Mansour A, Cholley B, Coutance G, Bouglé A. Perioperative Management of Heart Transplantation: A Clinical Review. Anesthesiology 2023; 139:493-510. [PMID: 37458995 DOI: 10.1097/aln.0000000000004627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
In this clinical review, the authors summarize the perioperative management of heart transplant patients with a focus on hemodynamics, immunosuppressive strategies, hemostasis and hemorrage, and the prevention and treatment of infectious complications.
Collapse
Affiliation(s)
- Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; National Institute of Health and Medical Research, Center of Clinical Investigation, Nutrition, Metabolism, Cancer Mixed Research Unit, University Hospital Federation Survival Optimization in Organ Transplantation, Rennes, France
| | - Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; National Institute of Health and Medical Research, Center of Clinical Investigation, Nutrition, Research Institute for Environmental and Occupational Health Mixed Research Unit, Rennes, France
| | - Bernard Cholley
- Department of Anesthesiology and Intensive Care Medicine, European Hospital Georges Pompidou, Public Hospitals of Paris, Paris, France; Paris Cité University, National Institute of Health and Medical Research Mixed Research Unit, Paris, France
| | - Guillaume Coutance
- Sorbonne University, Public Hospitals of Paris, Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié-Salpêtrière Hospital, Paris, France
| | - Adrien Bouglé
- Sorbonne University, Clinical Research Group in Anesthesia, Resuscitation, and Perioperative Medicine, Public Hospitals of Paris, Department of Anesthesiology and Critical Care, Cardiology Institute, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
3
|
Flynn BC, Steiner ME, Mazzeffi M. Off-label Use of Recombinant Activated Factor VII for Cardiac Surgical Bleeding. Anesthesiology 2023:138187. [PMID: 37155359 DOI: 10.1097/aln.0000000000004569] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Recombinant activated factor VII has been widely used in an off-label manner for cardiac surgical bleeding. Recent reports have administered recombinant activated factor VII earlier in the course of bleeding and at lower doses than initially reported. This review will discuss the history, mechanism, current recommendations for use, and recent data on the use of recombinant activated factor VII in cardiac surgical bleeding.
Collapse
Affiliation(s)
- Brigid C Flynn
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Marie E Steiner
- Divisions of Hematology/Oncology and Critical Care, University of Minnesota, Minneapolis, Minnesota
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
| |
Collapse
|
4
|
Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
5
|
Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
6
|
Kidd B, Sutherland L, Jabaley CS, Flynn B. Efficacy, Safety, and Strategies for Recombinant-Activated Factor VII in Cardiac Surgical Bleeding: A Narrative Review. J Cardiothorac Vasc Anesth 2021; 36:1157-1168. [PMID: 33875351 DOI: 10.1053/j.jvca.2021.03.021] [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: 01/23/2021] [Revised: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
As perioperative bleeding continues to be a major source of morbidity and mortality in cardiac surgery, the search continues for an ideal hemostatic agent for use in this patient population. Transfusion of blood products has been associated both with increased costs and risks, such as infection, prolonged mechanical ventilation, increased length of stay, and decreased survival. Recombinant-activated factor VII (rFVIIa) first was approved for the US market in 1999 and since that time has been used in a variety of clinical settings. This review summarizes the existing literature pertaining to perioperative rFVIIa, in addition to society recommendations and current guidelines regarding its use in cardiac surgery.
Collapse
Affiliation(s)
- Brent Kidd
- Division of Critical Care Medicine, Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
| | - Lauren Sutherland
- Division of Critical Care Medicine, Department of Anesthesiology, Columbia University, New York, NY
| | - Craig S Jabaley
- Division of Critical Care Medicine, Department of Anesthesiology, Emory University, Atlanta, GA; Emory Critical Care Center, Atlanta, GA
| | - Brigid Flynn
- Division of Critical Care Medicine, Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
7
|
Giordanino EF, Absi DO, Favaloro LE, Renedo MF, Ratto RD, Rubira DM, Ameri A, Giunta G, Favaloro RR, Bertolotti AM. Short-term mechanical circulatory support devices as bridge to heart transplantation: A prospective single-center experience in Argentina. Clin Transplant 2020; 34:e13888. [PMID: 32358983 DOI: 10.1111/ctr.13888] [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] [Received: 02/26/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with cardiogenic shock may require hemodynamic stabilization with short-term mechanical circulatory support devices (ST-MCS) such as extracorporeal membrane oxygenation (ECMO) and centrifugal pump (CP) as bridge to transplantion (BTT). This study aimed to describe ECMO and CP during BTT and after heart transplant. METHODS A cohort of patients on ECMO or CP as BTT between April 2006 and April 2018 in a single hospital. RESULTS Thirty-seven consecutive patients with ECMO (n = 14) or CP (n = 23) were included. Acute kidney injury was more prevalent during CP (28.6% vs 69.6%, P = .02). There were no differences in stroke, thrombosis, sepsis, or vasoplegia. Bleeding (0% vs 56.5%, P = .0003) and reoperation (0% vs 47.8%, P = .002) were more frequent in CP group as well as mortality (0 vs 7 [30.4%], P = .03). The remaining 30 patients (81.1%) underwent heart transplantation, without differences in primary graft dysfunction, vasoplegia, reoperation for bleeding, or hospital stay. Mortality was 23.3% at 30 days, similar in both groups, with no further deaths at median follow-up of 44.2 months. CONCLUSIONS In patients with cardiogenic shock, ST-MCS with ECMO or CP as BTT are a lifesaving approach allowing successful transplantation in the majority of cases, with good short- and long-term survival.
Collapse
Affiliation(s)
- Elian F Giordanino
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Daniel O Absi
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Liliana E Favaloro
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Maria F Renedo
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Roxana D Ratto
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Daniela M Rubira
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Aldana Ameri
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Gustavo Giunta
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Roberto R Favaloro
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Alejandro M Bertolotti
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| |
Collapse
|
8
|
Karube T, Andersen C, Tobias JD. Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients. J Pediatr Intensive Care 2020; 9:106-112. [PMID: 32351764 DOI: 10.1055/s-0039-1700953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/06/2019] [Indexed: 01/21/2023] Open
Abstract
Coagulation disturbances frequently occur in critically ill children. Four-factor prothrombin complex concentrate (4F-PCC) may have a potential role in managing these patients while avoiding concerns associated with fresh frozen plasma. However, data on this product in critically ill children is scarce. We retrospectively identified 24 critically ill pediatric patients who received 4F-PCC. The primary indication was to correct coagulopathy and control bleeding in the trauma or surgical setting. 4F-PCC effectively decreased the international normalized ratio level, a surrogate marker of hemostasis. Further study is warranted to identify efficacy, indications, optimal dosing, and adverse effects in the critically ill pediatric patients.
Collapse
Affiliation(s)
- Takaharu Karube
- Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Courtney Andersen
- Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio, United States
| | - Joseph D Tobias
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
| |
Collapse
|
9
|
Jahangirifard A, Ahmadi ZH, Naghashzadeh F, Sharif-Kashani B, Rashid-Farokhi F, Afshar A, Yamini-Sharif R, Rezaei Y. Prophylactic Fibrinogen Decreases Postoperative Bleeding but Not Acute Kidney Injury in Patients Undergoing Heart Transplantation. Clin Appl Thromb Hemost 2017; 24:998-1004. [PMID: 29050500 PMCID: PMC6714712 DOI: 10.1177/1076029617731625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study is the premier clinical attempt to scrutinize the practicability of prophylactic fibrinogen infusion in patients undergoing heart transplantation (HT). A total of 67 consecutive patients who had undergone HT between January 2012 and December 2014 were assessed. After exclusion of some patients, 23 patients were given preoperative 2 g fibrinogen concentrate over a period of 15 minutes after the termination of cardiopulmonary bypass pump and complete reversal of heparin, and 30 patients were not given. Some laboratories were measured before general anesthesia and at 6 and 24 hours after surgery. In addition, major adverse events were also evaluated during hospitalization. The mean age of the patients was 39.5 ± 11.4 years, with a predominance of male sex (77.4%). All laboratories at baseline were comparable between groups. The length of hospital stay was longer in the control group compared to the fibrinogen group (20 [16-22] vs 16 [12-19] days; P = .005). There was a trend for patients in the fibrinogen group to have more acute kidney injury (AKI) after surgery (10% vs 30.4%) and less reoperation for bleeding (20% vs 8.7%). The amount of postoperative bleeding was significantly higher in the control group compared to the fibrinogen group (P < .001). The number of packed red blood cell transfused during 24 hours after surgery was significantly lower in the fibrinogen group (P < .001). The transfusion of fibrinogen in patients undergoing HT may be associated with reductions in postoperative bleeding, the number of packed red blood cells, and hospital length of stay; however, it may enhance postoperative AKI.
Collapse
Affiliation(s)
- Alireza Jahangirifard
- 1 Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zargham Hossein Ahmadi
- 2 Lung Transplantation Research Center, National Research of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- 2 Lung Transplantation Research Center, National Research of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- 3 Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farin Rashid-Farokhi
- 4 Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Afshar
- 2 Lung Transplantation Research Center, National Research of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Yamini-Sharif
- 1 Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- 5 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Patel PA, Fabbro M. CON: Factor Concentrates Should Not Have an Expanded Role in the Routine Management of the Bleeding Cardiac Surgical Patient. J Cardiothorac Vasc Anesth 2017; 32:565-569. [PMID: 28918979 DOI: 10.1053/j.jvca.2017.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
| | - Michael Fabbro
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL
| |
Collapse
|