Factors Associated with Excessive Postoperative Blood Loss and Hemostatic Transfusion Requirements

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.

Download Full-text

Tranexamic acid versus Aprotinin: Effects on postoperative blood loss and transfusion requirements in patients undergoing elective primary coronary artery bypass grafting

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967380 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

J Kobba ◽

A Rinas ◽

F Beyersdorf

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Blood Loss ◽

Tranexamic Acid ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Postoperative Blood Loss ◽

Bypass Grafting ◽

Acid Versus ◽

Transfusion Requirements

Download Full-text

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.

Download Full-text

Reducing Perioperative Blood Loss in Patients Undergoing Total Hip Arthroplasty

The International Journal of Artificial Organs ◽

10.1177/039139889802100110 ◽

1998 ◽

Vol 21 (1) ◽

pp. 47-51

Author(s):

A. D'Ambrosio ◽

B. Borghi ◽

A. Damato ◽

G. D'Amato ◽

D. Antonacci ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

General Anesthesia ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Epidural Anaesthesia ◽

Postoperative Blood Loss ◽

Total Hip ◽

Perioperative Blood Loss ◽

Transfusion Requirements

In this prospective, randomised, double-blind study, we investigated the effect of epidural anaesthesia and an antifibrinolytic agent, Aprotinin (500,000 KIU in bolus before surgery and 500,000 KIU h-1 in drip form during surgery), on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty. Sixty patients were allocated randomly to four groups (A: epidural + general anesthesia + Aprotinin, B: epidural + general anesthesia + placebo (equal volume), C: general anaesthesia + Aprotinin, D: general anaesthesia + placebo). Postoperative analgesia: epidural analgesia in groups A and B, systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco, and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours. Perioperative blood loss, frequency and quantity of transfusions were significantly higher in group D (p < 0.0001). Total blood loss was reduced by 31.3% by epidural anaesthesia, 20.4% by Aprotinin and 51.4% using a combination of the two techiniques.

Download Full-text

Intra- and Postoperative Blood Loss and Transfusion Requirements in Children Undergoing Craniofacial Surgery

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000005492 ◽

2019 ◽

Vol 30 (6) ◽

pp. 1798-1801

Author(s):

Alexander Lindholm D’Amore ◽

Mads Rasmussen ◽

Leif Christensen ◽

Gorm von Oettingen ◽

Sven Erik Nørholt ◽

...

Keyword(s):

Blood Loss ◽

Craniofacial Surgery ◽

Postoperative Blood Loss ◽

Transfusion Requirements

Download Full-text

Comparison of two doses of aprotinin in patients receiving aspirin before coronary bypass surgery

Perfusion ◽

10.1177/026765910001500204 ◽

2000 ◽

Vol 15 (2) ◽

pp. 105-110 ◽

Cited By ~ 11

Author(s):

Sergio V Moran ◽

Guillermo Lema ◽

Jessica Medel ◽

Manuel J Irarrazaval ◽

Ricardo Zalaquett ◽

...

Keyword(s):

Blood Loss ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Drug Efficacy ◽

Coronary Bypass Surgery ◽

Postoperative Blood Loss ◽

Treatment Groups ◽

Group I ◽

Transfusion Requirements

This study was designed to evaluate efficacy and tolerability of two different doses of aprotinin in patients receiving aspirin before undergoing coronary artery bypass grafting. Forty-two patients were randomized to receive either placebo (group I), or aprotinin in doses of 4 000 000 KIU (group II) or 6 000 000 KIU (group III). Drug efficacy was determined by measuring postoperative blood loss and transfusion of blood products. Both doses were effective in reducing blood loss and transfusion requirements. Blood loss through thoracotomy drainage was 450 ± 224, 182 ± 144, 142 ± 98 ml, respectively, for control and treatment groups II and III ( p = 0.0001). The numbers of patients with blood transfusions were seven (50%), two (17%) and two (17%) for group I and treatment groups II and III, respectively ( p = 0.10). Tolerability was excellent and complications few and reversible. In conclusion, high and medium doses of aprotinin were well tolerated and reduced bleeding and transfusion requirements in patients submitted to coronary bypass surgery under the effects of aspirin.

Download Full-text

1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab259.1057 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Varma ◽

R Donovan ◽

M Whitehouse ◽

S Kunutsor ◽

A Blom

Keyword(s):

Systematic Review ◽

Blood Transfusion ◽

Length Of Stay ◽

Blood Loss ◽

Tranexamic Acid ◽

Meta Analysis ◽

Postoperative Blood Loss ◽

Perioperative Blood Loss ◽

Transfusion Requirements ◽

Elbow Replacement

Abstract Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER). We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications. Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay. This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.

Download Full-text