Abstract
ObjectiveThe goal of this study was to compare factor concentrate (FC)–based and blood product–based hemostasis management of coagulopathy in cardiac surgical patients in terms of postoperative bleeding, required blood products, and outcome. DesignRetrospective, propensity score–matched analysis. SettingSingle, tertiary, academic medical center. ParticipantsOne hundred eighteen matched pairs of 433 consecutive patients scheduled for cardiac surgery in two isolated periods with distinct strategies of hemostasis management. InterventionsPatients received either blood product–based (period I) or FC-based (period II) hemostasis management to treat perioperative coagulopathy. Measurements and Main ResultsPatients treated with FC management experienced less postoperative blood loss (907 v 1,153 mL, p = 0.014) and required less red blood cell and fresh frozen plasma transfusion (2.3 v 3.7 units p < 0.0001, and 2.0 v 3.4 units p < 0.0001, respectively) compared with subjects in the blood product–based management group. The frequency of Stage 3 acute kidney injury and 30-day mortality rate were significantly higher in the blood product–based group than in the FC management group (6.8% v 0.8%, p = 0.016, and 7.2% v 0.8%, p = 0.022, respectively). FC management-related thromboembolic events were not registered. The FC strategy was associated with a 2.19-fold decrease in the odds of massive postoperative bleeding (p < 0.0001), a 2.56-fold decrease in the odds of polytransfusion (p < 0.0001), and a 13.16-fold decrease in the odds of early postoperative death (p = 0.003). ConclusionsFC-based versus blood product–based management is associated with reduced blood product needs and fewer complications, and was not linked to a higher frequency of thromboembolic events or a decrease in long-term survival in cardiac surgical patients developing perioperative coagulopathy and bleeding.
Highlights
factor concentrate (FC)-based versus blood productÀbased management is associated with reduced blood product needs and fewer complications, and was not linked to a higher frequency of thromboembolic events or a decrease in long-term survival in cardiac surgical patients developing perioperative coagulopathy and bleeding
CLINICALLY SIGNIFICANT coagulopathy is a frequent complication of cardiac surgery, leading to increased risk of postoperative massive blood loss, reexploration, anemia, and polytransfusion.[1,2]
The perioperative blood loss, hemodilution, platelet activation, hypothermia, and large surgical surface result in a rapid development of hypofibrinogenemia and fibrinogen dysfunction, one of the key mechanisms of the complex coagulopathy associated with cardiac surgery.[6]
Summary
Over the screened periods (2011 and 2013), there were no relevant changes in surgical or anesthetic techniques in perioperative treatment apart from hemostasis management. Due to their chronologically close time frames, significant differences in the patient characteristics were not expected between the twwo observed periods. Demographic, perioperative clinical, and outcome data were collected from cardiac surgical, intensive care unit, and hospital healthcare digital databases and individual treatment charts (including anesthetic, transfusion, and observational charts, and perioperative FC use audit forms) provided by the institutional medical archives and the Department of Pharmacology and Pharmacotherapy. Exclusion criterion was long-term left ventricular assist device implantation
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