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

Objective. To evaluate the efficacy of tranexamic acid (TA) in cardiac surgery patients undergoing the open-heart surgery under conditions of artificial blood circulation (ABC) by determining the volume of perioperative blood loss using the hemoglobin balance method. Methods. A pilot non-randomized prospective clinical trial was conducted. To determine the effectiveness of TA use, 2 groups of patients were formed: the 1<sup>st</sup> group, without TA application (n=40), the 2<sup>nd</sup> group - with TA application intraoperatively (n=40). In group 2, prior to sternotomy, intravenous bolus injection of TA (1000 mg (20 ml of 5% solution)) was performed and further titration of TA through a syringe dispenser was continued at a rate of 4 ml/hour (200 mg/hour) until the end of the operation.The volume of intraoperative blood-loss was assessed by the hemoglobin balance method. A special protocol was developed to control the volume of postoperative blood loss. Results. The volume of circulating blood (VCB) calculated by Nadler’s formula for the first group was 5433.2 (5008.5; 5768.2) ml, for the second - 5214.0 (4944.1; 5546.8) ml. In the first group of patients who did not receive TA during open- heart surgery, the volume of blood loss was 1460.6 (1196.8; 1725.8) ml or 26.9 % of the average circulating blood volume (CBV), and in the second group of patients who received TA intraoperatively - 1090.7 (882.3; 1468.6) ml or 20.9% of the CBV (p<0,001). Conclusion. The application of TA in cardiac surgery patients during open-heart surgery with ABC according to the developed algorithm (1000 mg/bolus, titration during surgery-200 mg/h) for the purpose of blood saving the volume of blood-loss was reduced by 25.3% compared to the control group. What this paper adds Algorithm for the use of tranexamic acid to reduce perioperative blood loss in cardiac surgery using cardiopulmonary bypass (CPB) during open-heart surgery has been developed. This algorithm included intravenous tranexamic acid injection (1,000 mg.) followed by titration during the operation - 200 mg/h). The use of this algorithm in cardiac surgical procedures allows reducing the volume of blood loss by 25.3%.

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The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649883 ◽

1995 ◽

Vol 74 (04) ◽

pp. 1064-1070 ◽

Cited By ~ 76

Author(s):

Marco Cattaneo ◽

Alan S Harris ◽

Ulf Strömberg ◽

Pier Mannuccio Mannucci

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Meta Analysis ◽

Postoperative Blood Loss ◽

Controlled Trials ◽

Double Blind ◽

Double Blind Placebo ◽

Transfusion Requirements ◽

The Mean ◽

Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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