Does Intraoperative Hetastarch Administration Increase Blood Loss and Transfusion Requirements After Cardiac Surgery?

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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High-dose Aprotinin in Cardiac Surgery—A Prospective, Randomized Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200505 ◽

1994 ◽

Vol 22 (5) ◽

pp. 529-533 ◽

Cited By ~ 20

Author(s):

M. J. Swart ◽

P. C. Gordon ◽

P. B. Hayse-Gregson ◽

R. A. Dyer ◽

A. L. Swanepoel ◽

...

Keyword(s):

Cardiac Surgery ◽

Placebo Group ◽

Blood Loss ◽

Artery Bypass ◽

Randomized Study ◽

Postoperative Blood Loss ◽

High Dose ◽

Maintenance Infusion ◽

Transfusion Requirements ◽

High Dose Aprotinin

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

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Coagulation Tests, Blood Loss, and Transfusion Requirements in Platelet-Rich Plasmapheresed Versus Nonpheresed Cardiac Surgery Patients

Anesthesia & Analgesia ◽

10.1213/00000539-199401000-00007 ◽

1994 ◽

Vol 78 (1) ◽

pp. 29???36 ◽

Cited By ~ 36

Author(s):

Cynthia A. Wong ◽

Mark L. Franklin ◽

Leonard D. Wade

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Transfusion Requirements ◽

Coagulation Tests

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Albumin versus 6% HES 130/0.4 in pediatric cardiac surgery: effects on blood loss and transfusion requirements

European Journal of Anaesthesiology ◽

10.1097/00003643-201406001-00274 ◽

2014 ◽

Vol 31 ◽

pp. 100

Author(s):

M. Dumoulin ◽

A. De Villé ◽

C. Sanchez-Torres ◽

P. Van der Linden

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Pediatric Cardiac Surgery ◽

Transfusion Requirements

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Effect of Tranexamic Acid after Cardiac Surgery in Children

Cardiovascular Journal ◽

10.3329/cardio.v1i2.8127 ◽

1970 ◽

Vol 1 (2) ◽

pp. 189-192

Author(s):

MK Hassan ◽

KA Hasan ◽

ABMA Salam ◽

A Razzak ◽

S Ferdous ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Tranexamic Acid ◽

Pediatric Patients ◽

Acid Group ◽

Skin Incision ◽

Total Blood Loss ◽

Financial Cost ◽

Total Blood ◽

Transfusion Requirements

Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.Keywords: Tranexemic acid; Cardiac surgery; Post operative; bleeding DOI: http://dx.doi.org/10.3329/cardio.v1i2.8127 Cardiovasc. j. 2009; 1(2) : 189-192

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Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Perfusion ◽

10.1177/0267659116685418 ◽

2017 ◽

Vol 32 (5) ◽

pp. 350-362 ◽

Cited By ~ 6

Author(s):

Idris Ghijselings ◽

Dirk Himpe ◽

Steffen Rex

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Loss ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Postoperative Blood Loss ◽

Transfusion Requirements ◽

Significant Difference ◽

Secondary Outcomes

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

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