| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 1994;107:271-279
© 1994 Mosby, Inc.
CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES |
St. Louis, Mo.
(Supported in part by a research grant from Ciba Corning Diagnostics Corp., Medfield, Mass.)
Received for publication Feb. 2, 1993. Accepted for publication May 17, 1993. Address reprints: George Despotis, MD, Department of Anesthesiology, Box 8054, Washington University School of Medicine, 660 South Euclid Ave., St. Louis, MO 63110.
Abstract
Although laboratory coagulation tests permit a rational approach to both diagnosis and management of coagulation disorders after cardiopulmonary bypass, their clinical utility is limited by delays in obtaining results. This study was designed to evaluate prospectively the impact of on-site coagulation testing on blood product use, operative time, and intraoperative management of microvascular bleeding. Patients who underwent cardiac procedures involving cardiopulmonary bypass and subsequently developed microvascular bleeding were randomly assigned to receive either standard therapy (n = 36) or therapy defined by a treatment algorithm based on results from an on-site coagulation monitoring laboratory (n = 30). No differences were found between treatment groups in hematologic assay data, operative procedures, or duration of cardiopulmonary bypass. Patients treated in accordance with on-site laboratory results (algorithm therapy) received significantly less intraoperative fresh frozen plasma (0.4 ± 1.1 U versus 2.4 ± 2.8 U; p = 0.0006) during the treatment interval, had shorter operative times, and had less mediastinal chest tube drainage during the initial perioperative interval (158 ± 169 ml versus 326 ± 258 ml; p = 0.003) than did patients in the standard therapy group. Patients who underwent algorithm therapy also received fewer platelet (1.6 ± 5.9 versus 6.4 ± 8.2 U; p = 0.02) and red blood cell (1.9 ± 1.7 U versus 4.1 ± 4.1U; p = 0.01) transfusions after the operation. Nine of 36 (25%) standard group patients received initial therapy which differed from that which would have been guided by the on-site algorithm protocol. Our findings indicate that rapid and accurate coagulation test results can guide specific therapy and optimize treatment of microvascular bleeding in patients who undergo cardiac operations. (J THORAC CARDIOVASC SURG 1994;107:271-9)
This article has been cited by other articles:
|
|
 |
|
  P. J. Van der Linden, J.-F. Hardy, A. Daper, A. Trenchant, and S. G. De Hert Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome? Br. J. Anaesth., November 1, 2007; 99(5): 646 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. De Hert, S. Lorsomradee, S. Cromheecke, and P. J. Van der Linden The Effects of Levosimendan in Cardiac Surgery Patients with Poor Left Ventricular Function Anesth. Analg., April 1, 2007; 104(4): 766 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Van der Linden, S. G. De Hert, D. Deraedt, S. Cromheecke, K. De Decker, R. D. Paep, I. Rodrigus, A. Daper, and A. Trenchant Hydroxyethyl Starch 130/0.4 Versus Modified Fluid Gelatin for Volume Expansion in Cardiac Surgery Patients: The Effects on Perioperative Bleeding and Transfusion Needs Anesth. Analg., September 1, 2005; 101(3): 629 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Samama, R. Djoudi, T. Lecompte, N. Nathan-Denizot, J.-F. Schved, and the AFSSAPS Expert Group Perioperative platelet transfusion: recommendations of the Agence francaise de securite sanitaire des produits de sante (AFSSaPS) 2003: [Transfusion perioperatoire de plaquettes : recommandations de l'Agence francaise de securite sanitaire des produits de sante (AFSSaPS) 2003] Can J Anesth, January 1, 2005; 52(1): 30 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Van der Linden, S. G. De Hert, A. Daper, A. Trenchant, D. Schmartz, P. Defrance, and P. Kimbimbi 3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients: [La gelatine a pont d'uree a 3,5 % est aussi efficace que de l'HEA 200/0,5 a 6 % pour le remplissage vasculaire des patients de chirurgie cardiaque] Can J Anesth, March 1, 2004; 51(3): 236 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Oliver Jr Overview of Heparin and Protamine Management and Dosing Regimens in Pediatric Cardiac Surgical Patients Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 387 - 410. [Abstract] [PDF]
|
|
|
|
|
|
R. R. Johi, M. H. Cross, and S. D. Hansbro Near-patient testing for coagulopathy after cardiac surgery{dagger} Br. J. Anaesth., April 1, 2003; 90(4): 499 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M.-H. Ho, A. Lee, E. Ling, A. Daly, K. Teoh, and T. E. Warkentin Agreements Between the Prothrombin Times of Blood Treated In Vitro with Heparinase During Cardiopulmonary Bypass (CPB) and Blood Sampled After CPB and Systemic Protamine Anesth. Analg., January 1, 2003; 96(1): 15 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Cammerer, W. Dietrich, T. Rampf, S. L. Braun, and J. A. Richter The Predictive Value of Modified Computerized Thromboelastography and Platelet Function Analysis for Postoperative Blood Loss in Routine Cardiac Surgery Anesth. Analg., January 1, 2003; 96(1): 51 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. S Hall and A. J Skoultchi Transfusion for Coagulopathy After Heart Surgery: Efficacy of Laboratory Studies Asian Cardiovasc Thorac Ann, March 1, 2002; 10(1): 16 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ferring, G. Reber, P. de Moerloose, P. Merlani, M. Diby, and B. Ricou Point of care and central laboratory determinations of the aPTT are not interchangeable in surgical intensive care patients : [Les examens visant a determiner le TCA, realises au chevet du malade ou dans un laboratoire central, ne sont pas interchangeables pour les patients des soins intensifs chirurgicaux] Can J Anesth, December 1, 2001; 48(11): 1155 - 1160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Samson and L. Shore-Lesserson Platelet Function and Cardiopulmonary Bypass Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 273 - 281. [Abstract] [PDF]
|
|
|
|
 |
|
 G. J. Despotis, M. S. Avidan, and C. W. Hogue Jr Mechanisms and attenuation of hemostatic activation during extracorporeal circulation Ann. Thorac. Surg., November 1, 2001; 72(5): S1821 - 1831. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Van der Linden, S. De Hert, A. Daper, A. Trenchant, D. Jacobs, C. De Boelpaepe, P. Kimbimbi, P. Defrance, and G. Simoens A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery : [L'approche systematique et multidisciplinaire diminue le recours aux produits sanguins allogenes chez les malades operes du coeur] Can J Anesth, October 1, 2001; 48(9): 894 - 901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Shore-Lesserson Monitoring the Hematologic Complications of Cardiopulmonary Bypass Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 207 - 216. [Abstract] [PDF]
|
|
|
|
|
|
N. J. Skubas and G. J. Despotis Optimal Management of Bleeding Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 217 - 228. [Abstract] [PDF]
|
|
|
|
|
|
G. J. Despotis, C. W. Hogue, R. Saleem, M. Bigham, N. Skubas, I. Apostolidou, A. Qayum, and J. H. Joist The Relationship Between Hirudin and Activated Clotting Time: Implications for Patients with Heparin-Induced Thrombocytopenia Undergoing Cardiac Surgery Anesth. Analg., July 1, 2001; 93(1): 28 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Levy Platelet inhibitors and bleeding in cardiac surgical patients Ann. Thorac. Surg., August 1, 2000; 70(2): S9 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Despotis and L. T. Goodnough Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Gruenwald, V de Souza, A K. Chan, and M Andrew Whole blood heparin concentrations do not correlate with plasma antifactor Xa heparin concentrations in pediatric patients undergoing cardiopulmonary bypass Perfusion, May 1, 2000; 15(3): 203 - 209. [Abstract] [PDF]
|
|
|
|
 |
|
 M. G. Scott Faster Is Better--It’s Rarely That Simple! Clin. Chem., April 1, 2000; 46(4): 441 - 442. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Nichols, T. S. Kickler, K. L. Dyer, S. K. Humbertson, P. C. Cooper, W. L. Maughan, and D. G. Oechsle Clinical Outcomes of Point-of-Care Testing in the Interventional Radiology and Invasive Cardiology Setting Clin. Chem., April 1, 2000; 46(4): 543 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. De Bonis, F. Cavaliere, F. Alessandrini, E. Lapenna, F. Santarelli, U. Moscato, R. Schiavello, and G. F. Possati TOPICAL USE OF TRANEXAMIC ACID IN CORONARY ARTERY BYPASS OPERATIONS: A DOUBLE-BLIND, PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED STUDY J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 575 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Kost, S. S. Ehrmeyer, B. Chernow, J. W. Winkelman, G. P. Zaloga, R. P. Dellinger, and T. Shirey The Laboratory-Clinical Interface: Point-of-Care Testing Chest, April 1, 1999; 115(4): 1140 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Shore-Lesserson, H. E. Manspeizer, M. DePerio, S. Francis, F. Vela-Cantos, and M. A. Ergin Thromboelastography-Guided Transfusion Algorithm Reduces Transfusions in Complex Cardiac Surgery Anesth. Analg., February 1, 1999; 88(2): 312 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Rainey Outcomes Assessment for Point-of-Care Testing Clin. Chem., August 1, 1998; 44(8): 1595 - 1596. [Full Text] [PDF]
|
|
|
|
|
|
G. J. Despotis, J. H. Joist, and L. T. Goodnough Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes Clin. Chem., September 1, 1997; 43(9): 1684 - 1696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. T. Goodnough, G. J. Despotis, C. W. Hogue Jr, and T. B. Ferguson Jr On the Need for Improved Transfusion Indicators in Cardiac Surgery Ann. Thorac. Surg., August 1, 1995; 60(2): 473 - 480. [Abstract] [Full Text]
|
|
|
|
|
|
G. J. Despotis, J. H. Joist, C. W. Hogue Jr., A. Alsoufiev, K. Kater, L. T. Goodnough, S. A. Santoro, E. Spitznagel, M. Rosenblum, and D. G. Lappas The impact of heparin concentration and activated clotting time monitoring on blood conservation: A prospective, randomized evaluation in patients undergoing cardiac operation J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 46 - 54. [Abstract] [Full Text]
|
|
|
|
|
|
G. J. Despotis, A. L. Summerfield, J. H. Joist, L. T. Goodnough, S. A. Santoro, E. Spitznagel, J. L. Cox, and D. G. Lappas Comparison of activated coagulation time and whole blood heparin measurements with laboratory plasma anti-Xa heparin concentration in patients having cardiac operations J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1076 - 1082. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
