scholarly journals Fibrinogen and Bleeding in Adult Cardiac Surgery: A Review of the Literature

Surgeries ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 409-436
Author(s):  
Višnja Ikić
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Clinical Settings ◽  
Transfusion Requirements ◽  
Pubmed Database ◽  
Blood Clots ◽  
Therapeutic Procedures ◽  
Adult Cardiac Surgery

Background: Fibrinogen is a substrate for blood clots formation. In cardiac surgery, a number of different mechanisms lead to a decrease in fibrinogen levels and consequent impaired haemostasis. Patients undergoing cardiac surgery are therefore frequently exposed to blood loss and allogeneic blood transfusion, which are risk factors associated with morbidity and mortality. Thus, particular efforts in fibrinogen management should be made to decrease bleeding and the need for blood transfusion. Therefore, fibrinogen remains an active focus of investigations from basic science to clinical practice. This review aims to summarise the latest evidence regarding the role of fibrinogen and current practices in fibrinogen management in adult cardiac surgery. Methods: The PubMed database was systematically searched for literature investigating the role and disorders of fibrinogen in cardiac surgery and diagnostic and therapeutic procedures related to fibrinogen deficiency aimed at reducing blood loss and transfusion requirements. Clinical trials and reviews from the last 10 years were included. Results: In total, 146 articles were analysed. Conclusion: The early diagnosis and treatment of fibrinogen deficiency is crucial in maintaining haemostasis in bleeding patients. Further studies are needed to better understand the association between fibrinogen levels, bleeding, and fibrinogen supplementation and their impacts on patient outcomes in different clinical settings.

scholarly journals MODIFIED ULTRAFILTRATION IN ADULT CARDIAC SURGERY IS IT REALLY BENEFICIAL?

2007 ◽  
Vol 14 (04) ◽  
pp. 653-658
Author(s):  
SAFDAR ABBAS ◽  
M. SHAHAB NAQVI ◽  
Muhammad BAKHSH ◽  
Nouman Saddique
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Transfusion ◽  
Clinical Assessment ◽  
Postoperative Bleeding ◽  
Inotropic Support ◽  
Excess Water ◽  
Group I ◽  
Transfusion Requirements ◽  
Adult Cardiac Surgery

Background: Cardiopulmonary bypass initiates systemic inflammatoryresponse syndrome (SIRS) causing deleterious effects on various body systems with increased morbidity. Modifiedultrafiltration (MUF) is a technique that removes excess water and inflammatory mediators from the circulation in thepost-bypass period resulting in reduced bleeding, less blood transfusion requirements and overall reduced morbidity.Materials and Methods: 96 patients were randomly selected and divided into two groups. In Group I called MUF group(n=50), modified ultrafiltration was carried out for 15 min in the post bypass period. Group II called NON-MUFgroup(n=46), MUF was not carried out. Clinical assessment was based on ASA class. Mean cardiopulmonary bypass andaortic cross clamp times were 95.42 &56.94 min and 77.98 & 43.64 min in the MUF & NON-MUF groups respectively.Variables were expressed as mean and percentage. In the MUF group , there was increase in Hb by more than 2g/dlin 32 patients (64%) whereas in the NON-MUF group, this increase was only in 12 patients (20%). Mean postoperativechest drainage was far less (422 ml) in MUF group as compared to NON-MUF group (842.50 ml).Transfusion(449.12ml Vs 996.58 ml) and postoperative ventilatory requirements(40% Vs 47.8%) were also less in MUF group thanNON-MUF group. Inotropic support was nearly comparable in both the groups but overall morbidity (Low cardiac outputstate, sepsis, reopening) was less in the MUF group (18%) as compared to NON-MUF group (30%). Mean ICU staywas also less in MUF group (mean 51.52 hrs) than in NON-MUF group (mean 55.43 hrs). One patient in each groupdied. Conclusion: Modified Ultrafiltration is associated with improved hemoglobin, less postoperative bleeding,reopening and transfusion requirements with overall reduced morbidity and ICU stay. However, the need for inotropeswere not significantly different in the two groups.

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

1995 ◽  
Vol 74 (04) ◽  
pp. 1064-1070 ◽  
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.

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

1994 ◽  
Vol 22 (5) ◽  
pp. 529-533 ◽  
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.

scholarly journals What Is the Role of Long-Acting Neuromuscular Blocking Agents in Modern Adult Cardiac Surgery?

2016 ◽  
Vol 30 (5) ◽  
pp. e45-e46
Author(s):  
Marina Pieri ◽  
Alessandro Belletti ◽  
Giovanni Affronti ◽  
Veronica Dalessandro ◽  
Ada Carla Alba ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Blocking Agents ◽  
Long Acting ◽  
Adult Cardiac Surgery

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

2000 ◽  
Vol 9 (4) ◽  
pp. 801-807 ◽  
Author(s):  
Jill E. Knutson ◽  
Jane A. Deering ◽  
Frank W. Hall ◽  
Gregory A. Nuttall ◽  
Darrell R. Schroeder ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Transfusion Requirements ◽  
Increase Blood Loss

scholarly journals OPRM1 and COMT polymorphisms: implications on postoperative acute, chronic and experimental pain after cardiac surgery

2020 ◽  
Vol 21 (3) ◽  
pp. 181-193 ◽  
Author(s):  
Maja Matic ◽  
Sjoerd de Hoogd ◽  
Saskia N de Wildt ◽  
Dick Tibboel ◽  
Catherijne AJ Knibbe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pain Sensitivity ◽  
Secondary Analysis ◽  
Experimental Pain ◽  
Thermal Pain ◽  
Pain Outcomes ◽  
Average Pain ◽  
Postoperative Morphine ◽  
Adult Cardiac Surgery

Aim: Investigate the potential role of OPRM1 (mu-opioid receptor) and COMT (catechol-O-methyltransferase enzyme) polymorphisms in postoperative acute, chronic and experimental thermal pain. Methods: A secondary analysis of 125 adult cardiac surgery patients that were randomized between fentanyl and remifentanil during surgery and genotyped. Results: Patients in the fentanyl group with the COMT high-pain sensitivity haplotype required less postoperative morphine compared with the average-pain sensitivity haplotype (19.4 [16.5; 23.0] vs 34.6 [26.2; 41.4]; p = 0.00768), but not to the low-pain sensitivity group (30.1 [19.1; 37.7]; p = 0.13). No association was found between COMT haplotype and other pain outcomes or OPRM1 polymorphisms and the different pain modalities. Conclusion: COMT haplotype appears to explain part of the variability in acute postoperative pain in adult cardiac surgery patients.

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