scholarly journals Transfusion Requirements in Anemic Patients undergoing Cardiac Surgery

2017 ◽  
Vol 2 (1) ◽  
pp. 26-27
Author(s):  
Vaishali S Badge ◽  
Henry Skinner
Keyword(s):  
Cardiac Surgery ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
Transfusion Rate ◽  
Allergic Reactions ◽  
Blood Products ◽  
Transfusion Requirements

ABSTRACT Cardiac surgery is one of the largest consumer of blood and blood products in medicine. The transfusion rate in cardiac surgery accounts to almost 40-90%. Although lifesaving, it still increases the risk of allergic reactions, risk of transmission of infection, increased morbidity and mortality. The aim of this study was to find out causes of anaemia and requirement of blood or blood products in cardiac surgical patients. How to cite this article Badge VS, Skinner H. Transfusion Requirements in Anemic Patients undergoing Cardiac Surgery. Res Inno in Anesth 2017;2(1):26-27.

scholarly journals Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. e011069 ◽  
Author(s):  
Nicholas Gregory Ross Bayfield ◽  
Adrian Pannekoek ◽  
David Hao Tian
Keyword(s):  
Cardiac Surgery ◽  
Smoking Status ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Neurological Complications ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
Short Term ◽  
Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95%  CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95%  CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95%  CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

Evaluation of Erythropoietin Stimulating Agents (ESA) and Their Effect on Blood Optimization for Cardiac Surgery

2020 ◽  
pp. 089719002096927
Author(s):  
Kristina S. Gill ◽  
Abigail D. Antigua ◽  
A. Kacee Barnett ◽  
Aubrey J. Hall ◽  
Charles T. Klodell
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Retrospective Cohort ◽  
Blood Transfusions ◽  
Transfusion Rate ◽  
Blood Products ◽  
Single Center ◽  
Drug Reactions ◽  
Significant Difference ◽  
Erythropoietin Stimulating Agents

Background: Cardiovascular surgeries increase the risk of receiving blood transfusions. Erythropoietin stimulating agents (ESAs) have been used to decrease the transfusion rate. The objective of this study was to evaluate the administration of blood products post-cardiothoracic surgery after receiving ESAs. Methods: This is a single-center, retrospective cohort study. Results: Between May 2017 to May 2018, 52 adult patients underwent cardiac surgery and received ESAs pre-operatively and/or post-operatively. A total of 35 patients were included in the study and 21 (60%) patients did not require a blood transfusion while 14 (40%) patients required a blood transfusion ( p = 0.597). The change in hemoglobin (Hgb = 0.773 g/dL, 1.7 g/dL; p = 0.002) and hematocrit (Hct = 2.31%, 4.3%; p = 0.04) was significantly different in patients who received ESAs alone versus ESAs with blood transfusion. Adverse drug reactions showed no significant difference between groups. Conclusions: In patients undergoing cardiac surgery, ESAs did not significantly reduce the need for blood transfusion. Future and larger studies are necessary to evaluate the effect of ESAs on blood transfusion.

Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Oral Presentations: Perioperative red cell salvage in paediatric cardiac surgery

2006 ◽  
Vol 16 (3) ◽  
pp. 316-316
Author(s):  
S. Salam ◽  
D. Abrams ◽  
A. Kelleher ◽  
J. La Rovere
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Red Cell ◽  
Infectious Agents ◽  
Cell Salvage ◽  
Blood Products ◽  
Potential Health ◽  
Transfusion Requirements

Objective: In recent years blood transfusion has become a debated health care issue. To minimise exposure to infectious agents and reduce bank blood transfusion requirements, leucocyte filtration and perioperative red cell salvage (RCS) are increasingly used in paediatric patients. We hypothesised RCS would reduce the need for additional blood products in children following cardiopulmonary bypass (CPB). Methods: Patients undergoing routine or emergency cardiac surgery requiring CPB over a study period of 3 months were included prospectively in the analysis. Haemoglobin, platelet count, coagulation screen and heparin levels were performed before, immediately after surgery and 24 hours later. RCS was performed in theatre according to surgical and anaesthetic preference. Red cells were salvaged from the surgical site, anticoagulated, washed and following resuspension in saline reinfused into the patient within 4 hours. The incidence of post-operative bleeding (>10 ml/kg/hr) was recorded, as was the need for additional red blood cells, platelets and fresh frozen plasma (FFP). The need for blood products was at the discretion of the consultant intensivist. Statistical analysis was performed using student t-test and Chi squared methods. Significance was accepted as p < 0.05. Results: Thirty-five consecutive patients (34.54 ± 43.55 months, 13.48 ± 14.39 kg) were included in the analysis. A total of 17 infants <12 months were included, 9/24 who received RCS and 8/11 who did not (p 0.052). Cyanotic heart disease was seen in 40%. RCS was performed in 24 of 35 patients, who were significantly older (44.2 ± 44.1 vs. 13.6 ± 25.5, p 0.02) and heavier (16.6 ± 16.2 vs. 6.7 ± 4.7, p 0.01). No difference was seen in the prevalence of cyanosis between the two groups. Post-operative bleeding was seen in 21% who underwent RCS and 40% in those who did not (p 0.33). The need for additional red blood cells was significantly reduced in those who received RCS, 37.5% vs. 91%, p 0.003, as was the use of FFP, 8.3% vs. 45.5%, p 0.02. There was no difference in the need for platelet transfusion, p 0.2. Discussion: In this study RCS was performed on 68.5% of children following CPB. RCS significantly reduced the need for further blood and FFP transfusion, although this was not related to post-operative bleeding. This has important implications for both exposure to infectious agents and health economics. That children who underwent RCS were older and heavier may be related to the complexity of surgery and CPB in younger patients, although infants were represented in both groups. A further analysis of potential health and economic benefits in a homogenous group is needed.

scholarly journals Fibrinogen Concentrate Vs. Cryoprecipitate for Acquired Hypofibrinogenemia in Cardiac Surgery — the FIBRES Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5080-5080
Author(s):  
Jo Carroll ◽  
Keyvan Karkouti
Keyword(s):  
Cardiac Surgery ◽  
Treatment Algorithm ◽  
Allogeneic Blood ◽  
Surgical Patients ◽  
High Risk Population ◽  
Fibrinogen Concentrate ◽  
Blood Products ◽  
Human Fibrinogen ◽  
Increased Risk ◽  
Patient Consent

Abstract Introduction: Cardiac surgery involving cardiopulmonary bypass (CPB) is associated with coagulopathy and excessive bleeding. This often requires the transfusion of large volumes of allogeneic blood products and is linked to an increased risk of adverse outcomes. A primary cause of coagulopathy is acquired hypofibrinogenemia; when fibrinogen levels drop below 1.5-2 mg/L, fibrinogen supplementation is required to maintain hemostasis. The FIBrinogen REplenishment in Surgery (FIBRES) study aims to compare the standard intervention, cryoprecipitate, with a new highly purified, double virus-inactivated human fibrinogen concentrate. Methods: The FIBRES study (NCT03037424) is a pragmatic, multicenter, active-control, randomized, single-blinded, non-inferiority phase 3 trial in adult patients undergoing cardiac surgery with CPB. The study will enroll patients with clinically significant bleeding associated with acquired hypofibrinogenemia. Patients for whom fibrinogen supplementation is ordered within 24 hours of surgery will be randomized to receive fibrinogen concentrate (4 g; Fibryga; Octapharma) or cryoprecipitate (10 units; dose equivalent to 4 g fibrinogen concentrate) (Figure 1). All randomized patients will receive fibrinogen supplementation as clinically indicated. Owing to the emergency nature of the clinical setting, patient consent at the point of randomization will be waived, with written informed consent obtained within 24-48 hours thereafter. The primary outcome is total allogeneic blood products (red blood cells, plasma, platelets) administered within the first 24 hours of surgery. Secondary outcomes include blood product use within 7 days, incidence of major bleeding within 24 hours, fibrinogen levels, and adverse events (AEs) and serious AEs within 28 days. Enrolment of 1,200 patients will provide >90% power to demonstrate non-inferiority, assuming a 20% non-inferiority margin, ≥550 patients per group, and an approximate 10% drop-out rate. One pre-planned interim analysis will be conducted after data are available for 600 evaluable patients with the option to stop early for futility or overwhelming efficacy. The pragmatic design and treatment algorithm align with standard practice, aiding adherence and generalizability. Results: To date, 530 patients have been treated across 11 sites. An IDMEAC review of safety has been performed every 100 patients enrolled, with the recommendation to continue as planned each time. The study is expected to complete in late 2018, with results available in early 2019. Conclusions: The FIBRES study is the largest randomized study to date of fibrinogen concentrate versus cryoprecipitate in adult cardiac surgical patients, an under-studied yet high-risk population. Non-inferiority of the new fibrinogen concentrate would support its use for patients developing acquired hypofibrinogenemia during cardiac surgery. Results from the FIBRES study are likely to improve care for cardiac surgical patients experiencing significant bleeding. Disclosures Karkouti: Octapharma US: Research Funding.

scholarly journals Factor VIII Inhibitor Bypass Activity (FEIBA) for the Reduction of Transfusion in Cardiac Surgery: A Randomized, Double-Blind, Placebo-controlled, Pilot Trial

2020 ◽  
Author(s):  
Valerie A Sera ◽  
Ann E Stevens ◽  
Howard K Song ◽  
Victor M Rodriguez ◽  
Frederick A Tibayan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prothrombin Complex Concentrate ◽  
Rescue Therapy ◽  
Circulatory Arrest ◽  
Pilot Trial ◽  
Factor Viii Inhibitor ◽  
Bleeding Diathesis ◽  
Blood Products ◽  
Double Blind ◽  
Transfusion Requirements

Abstract BackgroundUncontrolled bleeding after cardiac surgery can be life threatening. Factor eight inhibitor bypassing activity (FEIBA) is a prothrombin complex concentrate empirically used as rescue therapy for correction of refractory bleeding diathesis post cardiopulmonary bypass (CPB). FEIBA use as rescue therapy for bleeding diathesis after CPB has been associated with a low incidence of complications and a reduction in transfusion requirement and re-exploration. The feasibility and efficacy of early administration of FEIBA after termination of CPB have not been studied.MethodsWe designed a small randomized, double-blinded, placebo-controlled pilot trial to determine the feasibility of a larger trial testing the hypothesis that FEIBA decreases transfusion requirements after CPB. Twelve adult patients undergoing elective major aortic cardiovascular surgery at a tertiary referral hospital were equally randomized to receive a single dose of either FEIBA or matched placebo intraoperatively at the end of CPB. The study was designed to evaluate the feasibility of a larger pivotal trial to determine the effectiveness of FEIBA in reducing the total volume of blood products transfused perioperatively, and its safety profile.ResultsThere were no protocol deviations or events of unblinding, and adverse events were not different between groups. Patients in the FEIBA group were older, more likely to be female, had higher BMI, lower hematocrit, and longer hypothermic circulatory arrest. There were no differences in post randomization blood product transfusions (difference FEIBA vs. placebo: -899 mL; 95%CI: -5,206 to 3,409, p=0.65).ConclusionsThis pilot trial confirmed the adequacy of the trial design that involved the early, blinded administration of FEIBA, by demonstrating excellent protocol adherence. We conclude that a larger trial establishing the effectiveness of early prothrombin complex concentrate administration to reduce the use of blood products in the setting of high-risk cardiac surgery is feasible. Trial RegistrationClinicalTrials.gov NCT02577614, Registered 16 October, 2015, https://clinicaltrials.gov/ct2/show/NCT02577614

scholarly journals Over-the-counter natural products in cardiac surgery: a case of ginseng-related massive perioperative bleeding

2017 ◽  
pp. bcr-2016-218068 ◽  
Author(s):  
Alessandro Viviano ◽  
Duncan Steele ◽  
Mark Edsell ◽  
Marjan Jahangiri
Keyword(s):  
Cardiac Surgery ◽  
High Volume ◽  
Surgical Patients ◽  
Blood Products ◽  
Over The Counter ◽  
Perioperative Bleeding ◽  
Drug History ◽  
Volume Blood ◽  
Coagulation Status ◽  
Severe Coagulopathy

We present a case of massive perioperative bleeding due to severe coagulopathy following urgent aortic and mitral valve replacement. Bleeding was persistent despite prolonged and meticulous surgical haemostasis and required high-volume blood products transfusions. No obvious cause was found to justify the severity of the coagulopathy, which was later attributed to high preoperative intake of ginseng.This case highlights the powerful activity of certain over-the-counter remedies on haemostasis, in this particular case on coagulation status. This also reminds us the paramount importance of a sound and comprehensive drug history for surgical patients.

scholarly journals Factor VIII Inhibitor Bypass Activity (FEIBA) for the Reduction of Transfusion in Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled, Pilot Trial

2020 ◽  
Author(s):  
Valerie A Sera ◽  
Ann E Stevens ◽  
Howard K Song ◽  
Victor M Rodriguez ◽  
Frederick A Tibayan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prothrombin Complex Concentrate ◽  
Rescue Therapy ◽  
Circulatory Arrest ◽  
Pilot Trial ◽  
Factor Viii Inhibitor ◽  
Bleeding Diathesis ◽  
Blood Products ◽  
Double Blind ◽  
Transfusion Requirements

Abstract Background Uncontrolled bleeding after cardiac surgery can be life threatening. Factor eight inhibitor bypassing activity (FEIBA) is a prothrombin complex concentrate empirically used as rescue therapy for correction of refractory bleeding diathesis post cardiopulmonary bypass (CPB). FEIBA use as rescue therapy for bleeding diathesis after CPB has been associated with a low incidence of complications and a reduction in transfusion requirement and re-exploration. The feasibility and efficacy of early administration of FEIBA after termination of CPB have not been studied.Methods We designed a small randomized, double-blinded, placebo-controlled pilot trial to determine the feasibility of a larger trial testing the hypothesis that FEIBA decreases transfusion requirements after CPB. Twelve adult patients undergoing elective major aortic cardiovascular surgery at a tertiary referral hospital were equally randomized to receive a single dose of either FEIBA or matched placebo intraoperatively at the end of CPB. The study was designed to evaluate the feasibility of a larger pivotal trial to determine the effectiveness of FEIBA in reducing the total volume of blood products transfused perioperatively, and its safety profile.Results There were no protocol deviations or events of unblinding, and adverse events were not different between groups. Patients in the FEIBA group were older, more likely to be female, had higher BMI, lower hematocrit, and longer hypothermic circulatory arrest. There were no differences in post randomization blood product transfusions (difference FEIBA vs. placebo: -899 mL; 95%CI: -5,206 to 3,409, p = 0.65).Conclusions This pilot trial confirmed the adequacy of the trial design that involved the early, blinded administration of FEIBA, by demonstrating excellent protocol adherence. We conclude that a larger trial establishing the effectiveness of early prothrombin complex concentrate administration to reduce the use of blood products in the setting of high-risk cardiac surgery is feasible.Trial Registration: ClinicalTrials.gov Identifier: NCT02577614

Use of blood products in cardiac surgery

Perfusion ◽  
1997 ◽  
Vol 12 (3) ◽  
pp. 157-162 ◽  
Author(s):  
M C Renton ◽  
D BL McClelland ◽  
C J Sinclair
Keyword(s):  
Cardiac Surgery ◽  
Cell Mass ◽  
Red Cell ◽  
Blood Products ◽  
Elective Cardiac Surgery ◽  
Transfusion Requirements ◽  
Red Cell Mass ◽  
The Face ◽  
Preoperative Factors ◽  
Cardiac Operations

The quantity of blood products used perioperatively during cardiac surgery is known to vary widely between institutions. This study looked at the amount of blood products used perioperatively in 74 consecutive elective cardiac operations in one institution. The results are compared with those from other European centres and a cost analysis carried out. On average 2.33 ± 0.74 (95% confidence interval 1.93-2.77) units of red cell concentrate were transfused perioperatively per patient. Six (8%) patients received no blood products. In addition a number of preoperative factors were studied in an attempt to identify predictors of transfusion requirements. Age, preoperative haemoglobin, female sex and red cell mass were all found to have some predictive value. In the face of increasing demands on a limited supply of blood products we question the need for crossmatching more than four units of red cell concentrate in elective cardiac surgery.

scholarly journals Factor VIII inhibitor bypass activity (FEIBA) for the reduction of transfusion in cardiac surgery: a randomized, double-blind, placebo-controlled, pilot trial

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Valerie A. Sera ◽  
Ann E. Stevens ◽  
Howard K. Song ◽  
Victor M. Rodriguez ◽  
Frederick A. Tibayan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prothrombin Complex Concentrate ◽  
Rescue Therapy ◽  
Circulatory Arrest ◽  
Pilot Trial ◽  
Factor Viii Inhibitor ◽  
Bleeding Diathesis ◽  
Blood Products ◽  
Protocol Adherence ◽  
Transfusion Requirements

Abstract Background Uncontrolled bleeding after cardiac surgery can be life-threatening. Factor eight inhibitor bypassing activity (FEIBA) is a prothrombin complex concentrate empirically used as rescue therapy for correction of refractory bleeding diathesis post-cardiopulmonary bypass (CPB). FEIBA used as rescue therapy for bleeding diathesis after CPB has been associated with a low incidence of complications and a reduction in transfusion requirement and re-exploration. The feasibility and efficacy of early administration of FEIBA after the termination of CPB have not been studied in a prospective randomized trial. Methods We designed a small randomized, double-blinded, placebo-controlled pilot trial to determine the feasibility of a larger trial testing the hypothesis that FEIBA decreases transfusion requirements after CPB. The study was designed to evaluate the feasibility of a larger pivotal trial to determine the effectiveness of FEIBA in reducing the total volume of blood products transfused perioperatively, and its safety profile. Study participants were adult patients undergoing elective major aortic cardiovascular surgery at a tertiary referral hospital, who were equally randomized to receive a single dose of either FEIBA or matched placebo intraoperatively at the end of CPB. Results Twenty patients were screened and 12 were randomized and included in the analysis. Protocol adherence was high, and all patients received the study drug per intention-to-treat except one patient. There were no protocol deviations or events of unblinding, and adverse events were not different between groups. Patients in the FEIBA group were older and more likely to be female and had higher BMI, lower hematocrit, and longer hypothermic circulatory arrest. There were no differences in post-randomization blood product transfusions (difference FEIBA vs. placebo −899 mL; 95% CI −5206 to 3409) or in the administration of open-label FEIBA. Conclusions This pilot trial confirmed the adequacy of the trial design that involved the early, blinded administration of FEIBA, by demonstrating excellent protocol adherence. We conclude that a larger trial establishing the effectiveness of early prothrombin complex concentrate administration to reduce the use of blood products in the setting of high-risk cardiac surgery is feasible. Trial registration ClinicalTrials.gov, NCT02577614. Registered 16 October 2015

Transfusion Managament in Cardiac Surgery in British Columbia: Review of 8352 Patients.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2277-2277
Author(s):  
Maha A Badawi ◽  
Kate M Chipperfield
Keyword(s):  
Risk Factors ◽  
British Columbia ◽  
Cardiac Surgery ◽  
Mortality Data ◽  
Published Data ◽  
Fisher Exact Test ◽  
Blood Products ◽  
Specific Patient ◽  
Significant Variability ◽  
Transfusion Requirements

Abstract Abstract 2277 Background: Transfusion of blood products remains an essential intervention during hospitalization for cardiac surgeries. Published data reveal significant variability in the patterns of transfusion of blood products among different centers. In addition, published data suggest that allogenic transfusions are associated with worse outcomes in cardiac surgery patients. This project was conducted to investigate for significant variability in transfusion practices in the management of cardiac surgery patients in the 4 cardiac surgery centers within the province of British Columbia (BC). Secondary objectives include assessing for correlation of specific patient and surgical characteristics with risk of transfusion, in addition to comparing one-year mortality in patients who received transfusions with those who did not. Methods: A retrospective review of data collected through the BC Cardiac Registry (BCCR) was performed. All adult patients who underwent cardiac surgery in BC between January 1,2008 to December 31,2010 were included. The following patients were excluded: Jehovah's witnesses, heart transplantation recipients and patients who underwent aortic aneurysm repair not including aortic valve surgery. In patients who underwent more that one surgery within 365 days, data were only collected for the first cardiac surgery. The following data were collected: age, gender, type of surgery, clinical urgency, institution, preoperative hemoglobin, preoperative eGFR, duration of cardio-pulmonary bypass and use of cell saver technology. Mortality data over 1 year post operatively and quantities of packed red blood cells (PRBCs), frozen plasma (FP), platelets and cryoprecipitate (cryo) transfused during surgery and within 30 days afterwards were also collected. Cardiac surgery centers were anonymized. Chi-square test and Fisher exact test were used to analyze variation in transfusion requirements. Kaplan-Meir curves will be created for estimation of survival. Multivariate regression analysis will be used to identify risk factors for transfusion. Results: After excluding patients as outlined above, 8352 patients were included in the analysis. A summary of transfusion rates of different blood products in different types of cardiac surgeries among different centers is summarized in table 1. Statistical analysis is currently in progress to assess for association between transfusion of blood products and survival, in addition to multivariate analysis to identify risk factors for transfusion. Conclusions: Significant differences are noted in transfusion requirement of PRBCs, FP and platelets during and within 30 days of cardiac surgery among the four different cardiac surgery centers in British Columbia. The differences are not accounted for by surgery type alone. Further research is required to identify factors to account for the observed variability. Consideration will be made for development of further measures for standardization of transfusion management in this patient group. Disclosures: No relevant conflicts of interest to declare.

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