Heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass

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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Coagulation tests and their association with postoperative blood loss after cardiac surgery with cardiopulmonary bypass

Acta medica Lituanica ◽

10.6001/actamedica.v19i3.2442 ◽

2012 ◽

Vol 19 (3) ◽

pp. 166-171 ◽

Cited By ~ 1

Author(s):

Agnese Ozolina ◽

Eva Strike ◽

Antonina Sondore ◽

Indulis Vanags

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Loss ◽

Mean Value ◽

Postoperative Blood Loss ◽

Mean Values ◽

Coagulation Tests ◽

Range Correlation ◽

A Prospective Study ◽

Adult Cardiac Surgery

Background. Platelet count (PLT), activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen are standard coagulation tests used for patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Materials and methods. 83 adult cardiac surgery patients were en rolled into a prospective study. Blood samples for APTT, PT, PLT, fibrino gen were collected preoperatively (T0), on admission to the intensive care unit (T1), 6 and 24 hours postoperatively (T6, T24). 24-hour postopera tive blood loss (24h-PBL) was registered. Results. The highest APTT mean value was 47 ± 13 sec at T6, in creasing from the baseline by 37%. The lowest mean value of PLT was 140 ± 47 × 109/L at T24, decreasing from the baseline by 32.5%. PT and fibrinogen mean values at all time points were within the normal range. Correlation with 24h-PBL was shown by T0 and T6 fibrinogen (r = –0.5, r = –0.4, P

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Association Between Platelet Count and Postoperative Blood Loss in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass and Fresh Frozen Plasma Administration Guided by Thromboelastometry

Circulation Journal ◽

10.1253/circj.cj-17-0712 ◽

2018 ◽

Vol 82 (3) ◽

pp. 677-683 ◽

Cited By ~ 5

Author(s):

Junko Ichikawa ◽

Yoshiko Osada ◽

Mitsuharu Kodaka ◽

Keiko Nishiyama ◽

Makiko Komori

Keyword(s):

Cardiac Surgery ◽

Platelet Count ◽

Cardiopulmonary Bypass ◽

Blood Loss ◽

Fresh Frozen Plasma ◽

Postoperative Blood Loss ◽

Fresh Frozen ◽

Frozen Plasma

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Factor V Leiden Does Not Affect Bleeding in Aprotinin Recipients after Cardiopulmonary Bypass

Anesthesiology ◽

10.1097/01.anes.0000264767.41297.87 ◽

2007 ◽

Vol 106 (4) ◽

pp. 681-686 ◽

Cited By ~ 4

Author(s):

Johannes Boehm ◽

Joachim Burkhard Grammer ◽

Fabian Lehnert ◽

Wulf Dietrich ◽

Stefan Wagenpfeil ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Loss ◽

Factor V Leiden ◽

Postoperative Blood Loss ◽

Factor V ◽

Thromboembolic Complications ◽

Antiplatelet Treatment ◽

Factor V Leiden Mutation ◽

Increased Risk

Background Carriers of the factor V Leiden mutation (FVL) are resistant to activated protein C proteolysis. Therefore, they are at increased risk of thromboembolic events. Aprotinin is an unspecific proteinase inhibitor frequently used during cardiac surgery procedures to reduce bleeding. However, aprotinin may cause thromboembolic complications after cardiopulmonary bypass (CPB). The primary endpoint of this study was the amount of blood loss after CPB in aprotinin recipients, and secondary endpoints were thromboembolic complications. Methods A total of 1,447 consecutive patients who underwent cardiac surgery with CPB were prospectively enrolled. All patients were screened for FVL by a fluorescence-based polymerase chain reaction method. Linear and logistic regression analyses were performed to assess associations of FVL on bleeding and thromboembolic complications. Results One hundred seven individuals (7.4%) were heterozygous FVL carriers. No difference was found between FVL carriers and noncarriers regarding age, sex, CPB, type of operation, EuroSCORE, antiplatelet treatment, and reoperation. FVL was not significantly associated with postoperative blood loss, whereas a significant influence was found for female sex (P < 0.0001), duration of CPB (P < 0.0001), reoperation (P = 0.001), and preoperative antiplatelet treatment (P < 0.002). Multiple linear regression analysis for total blood loss had an observed power of at least 99%. FVL carriers faced the same risk for postoperative transfusion (P = 0.391), reoperation (P = 0.675), myocardial infarction (P = 0.44), stroke (P = 0.701), and 30-day mortality (P = 0.4) as did noncarriers. Conclusions These data suggest that FVL carriers do not have reduced blood loss compared with noncarriers. Furthermore, the combination of aprotinin and FVL does not enhance the risk for thromboembolic complications.

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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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DEPOSITION - Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic Acid in Open Cardiac Surgery

Case Medical Research ◽

10.31525/ct1-nct03954314 ◽

2019 ◽

Author(s):

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Tranexamic Acid ◽

Postoperative Blood Loss

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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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