Blood Product Transfusion Rates Research Articles

Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion.

We aimed to evaluate the characteristics, clinical outcomes, and blood product transfusion (BPT) rates of patients undergoing cardiac transplant (CT) while receiving uninterrupted anticoagulation and antiplatelet therapy. A retrospective, single-center, and observational study of adult patients who underwent CT was performed. Patients were classified into four groups: (1) patients without anticoagulation or antiplatelet therapy (control), (2) patients on antiplatelet therapy (AP), (3) patients on vitamin K antagonists (AVKs), and (4) patients on dabigatran (dabigatran). The primary endpoints were reoperation due to bleeding and perioperative BPT rates (packed red blood cells (PRBC), fresh frozen plasma, platelets). Secondary outcomes assessed included morbidity and mortality-related events. Of the 55 patients included, 6 (11%) received no therapy (control), 8 (15%) received antiplatelet therapy, 15 (27%) were on AVKs, and 26 (47%) were on dabigatran. There were no significant differences in the need for reoperation or other secondary morbidity-associated events. During surgery patients on dabigatran showed lower transfusion rates of PRBC (control 100%, AP 100%, AVKs 73%, dabigatran 50%, p=0.011) and platelets (control 100%, AP 100%, AVKs 100%, dabigatran 69%, p=0.019). The total intraoperative number of BPT was also the lowest in the dabigatran group (control 5.5 units, AP 5 units, AVKs 6 units, dabigatran 3 units; p=0.038); receiving significantly less PRBC (control 2.5 units, AP 3 units, AVKs 2 units, dabigatran 0.5 units; p=0.011). A Poisson multivariate analysis showed that only treatment on dabigatran reduces PRBC requirements during surgery, with an expected reduction of 64.5% (95% CI: 32.4%-81.4%). In patients listed for CT requiring anticoagulation due to nonvalvular atrial fibrillation, the use of dabigatran and its reversal with idarucizumab significantly reduces intraoperative BPT demand.

The Adherence to an Intraoperative Blood Product Transfusion Algorithm Is Associated With Reduced Blood Product Transfusions in Cardiac Surgical Patients Undergoing Coronary Artery Bypass Grafts and Aortic and/or Valve Replacement Surgery: A Single-Center, Observational Study

Objective(s)To demonstrate the value of a viscoelastic-based intraoperative transfusion algorithm to reduce blood product administration in adult cardiac surgical patients. DesignProspective observational. SettingQuaternary academic teaching hospital. ParticipantsCardiac surgical patients. InterventionsViscoelastic-based intraoperative transfusion algorithm. Measurements and Main ResultsWe compared intraoperative blood product transfusion rates in 184 cardiac surgical patients to 236 historical controls after implementing a viscoelastic-based algorithm. We found a 43.9% reduction in RBC units transfused (1.98 units ±2.24 vs 0.55 ±1.36; p=0.008). We found a reduction in transfusion of 23.8% for FFP (0.84 units ±1.4 vs 0.64 ±1.38; p=ns), 33.4% for platelets (0.90 units ±1.39 vs 0.60 ±131; p=ns), and 15.8% for cryoprecipitate (0.19 units ±0.54 vs 0.16 ±0.50; p=ns). There was no statistically significant difference in time to extubation (8.0 hours [4.0, 21.0] vs 8.0 [4.0, 22.3], reoperation for bleeding (15 (12.3%) vs 10 (10.6%), ICU LOS (51.0 hours [28.0, 100.5] vs. 53.5 [33.3, 99.0]) or hospital length of stay (9.0 days [6.0, 15.0] vs. 10.0 [7.0, 17.0]). Deviation from algorithm adherence was 32.7% (48/147). PRBC, FFP, platelets, cryoprecipitate and cell saver were significantly reduced in the Algorithm Compliant Cohort compared with Historical Controls while times to extubation, ICU and hospital lengths of stay did not reach significance. ConclusionsFollowing implementation of a viscoelastic-based algorithm, patients received fewer PRBC, FFP, platelets, cryoprecipitate and cell saver. Algorithm Compliant patients received fewer transfusions; however, reductions in times to extubation, ICU and hospital lengths of stay were not statistically significant compared with historical controls.

Preoperative Anemia as a Negative Risk Factor for Coronary Artery Bypass Grafting Surgery: A Retrospective Study

OBJECTIVES The objective of this study is to check the effects of Anemia on mortality and morbidity in patients having ischemic heart disease and undergoing coronary artery bypass graft surgery (CABG). METHODOLOGY The study involved all the patients who underwent isolated coronary artery bypass graft surgery from July 2019 to December 2022. The clinical data of patients was retrospectively collected from the departmental data pool and was then analyzed using the chi-square test and t-test. A p-value of less than 0.05 was considered significant. RESULTSThe study included 2570 patients who underwent isolated CABG; 78.2% of patients were males with a mean age of 57.87±9.20. Hypertension was the most common comorbidity (68.9%), followed by dyslipidemia (53.7%) & Diabetes mellitus (49.9%). The preoperative mean hematocrit was 30.05±17.85. Of these 2570 patients, 52.37% were anaemic with a mean age of 58.69±9.05. Anemic patients had a significantly higher rate of IABP insertion (P 0.02) and intra-operative blood product transfusion (P <0.001). Anemic patients had a significantly higher incidence of in-hospital mortality (P 0.04) and a higher rate of postoperative blood product transfusion (P <0.001). There is no significant difference in terms of prolonged ventilation, reintubation, or readmission to ICU; however, nonanemic patients have a significantly higher rate of re-opening for bleeding/ tamponade (P 0.01). CONCLUSION Preoperative anaemia increases the mortality and morbidity in ischemic heart disease patients undergoing coronary artery bypass grafting. To improve the outcomes in CABG surgery, preoperative anaemia should be thoroughly investigated and treated to improve the outcomes of surgery.

Yüksek vücut kitle indeksi, sağ lob canlı donörden karaciğer nakli alıcılarında postoperatif kanama ve safra komplikasyon oranlarını artıran bir faktör mü?

Purpose: High Body Mass Index emerges as an important perioperative and postoperative risk factor for liver transplantation We aimed to examine the effect of increased BMI on perioperative follow-up parameters and per-postoperative complications in liver transplant recipients.
 Materials and methods: One hundred and seventy-two patients who underwent living-donor liver transplantation for end stage liver cirrhosis were included in the study. Whether there was a difference between cold ischemia time, operation time, blood product transfusion rates, hospital, biliary complications, hepatic vein thrombosis, portal vein thrombosis, NASH etiology, postoperative hemorrhage, sepsis, and primary graft dysfunction were analyzed statistically in terms of those with a BMI of 25 and above and those below 25.
 Results: Anhepatic phase duration (p=0.047) and cold ischemia duration (p=0.009) were statistically longer in patients with BMI >25.
 Conclusion: Prolonged anhepatic phase and cold ischemia times may be important in terms of the effect of increased BMI on postoperative graft survival.

A Single-Center's Early Surgical Outcomes of Living Donor Liver Transplantation

Living donor liver transplantation (LDLT) has become an increasingly common surgical option because the number of cadaveric donors is insufficient to fulfill the organ needs of patients facing end-stage cirrhosis. Many centers are investigating different surgical techniques to achieve lower complication rates. We aimed to examine our complication rates in light of demographic data, graft data, and perioperative findings as a single-center experience. The study included one hundred and three patients who underwent LDLT for end-stage liver cirrhosis. Demographic data; sex; age; blood group; Model for End-Stage Liver Disease score; Child score; etiology; liver side; graft-to-recipient weight ratio; hepatic artery, portal vein, and bile anastomosis type rates; anhepatic phase; cold ischemia time; operation time; and blood product transfusion rates were analyzed. Biliary complications in patients with single or multiple biliary anastomoses, right or left liver transplants, and with or without hepatic artery thrombosis were analyzed statistically. There was no significant difference in biliary complications between patients who underwent single or multiple bile anastomosis (P=.231) or patients receiving right lobe and left lobe transplants (P=.315). Although there was no statistically significant difference in the rate of portal vein thrombosis between the regular and reconstructed portal vein anastomosis groups (P=.693), the postoperative portal vein thrombosis rate was statistically higher in patients with left lobe transplants (P=.044). Vascular and biliary complication rates can be reduced with increasing experience.

Demographics, Radiological Findings, and Predictors of Prolonged Hospitalization in Civilian Gunshot Wound Patients.

This study aims to characterize the demographic, clinical, and radiological features of gunshot wound (GSW) patients as well as identify predictors of prolonged hospitalization. In this retrospective study, a consecutive sampling method was used, including all patients with GSWs in any anatomical region. Data collection included demographic and clinical information, radiological findings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primary outcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used. We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of the studied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%), and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalent radiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergency department stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest rates of blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), and ICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOS was significantly associated with abnormalities in radiological findings, receiving blood products, and ICU admission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings [odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9), and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3). This study provides insights into factors influencing prolonged hospitalization in GSW patients, highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.

The prevalence of blood product transfusion after the implementation of a postpartum hemorrhage bundle: a retrospective cohort at a single safety net academic institution

Postpartum hemorrhage, defined as blood loss of ≥1000 mL within 24 hours after birth, is a leading cause of maternal morbidity and is associated with substantial financial and emotional burden. Based on societal and regulatory guidelines, in 2019, our institution adopted a postpartum hemorrhage prevention and management bundle based on the California Maternal Quality Care Collaborative initiatives. The study aimed to compare the prevalence of maternal blood product transfusion before and after the implementation of the bundle. This was a retrospective cohort study comparing the prevalence of blood product transfusion before and after the implementation of a California Maternal Quality Care Collaborative-based postpartum hemorrhage management bundle at a single safety net teaching hospital between October 2017 and December 2019 excluding a 4-month rollout period between September 2018 and December 2018. The study included all patients ≥18 years of age and at >20 weeks' gestation. Exclusion criteria were out-born deliveries, delivery at time of significant nonobstetrical trauma, and refusal of blood transfusion. The primary outcome was the frequency of any blood product transfusion in the pre- and postbundle implementation cohorts. Secondary outcomes included blood product transfusion type and amount, maternal death, intrauterine balloon placement, uterine artery embolization, unplanned peripartum hysterectomy, intensive care admission, and length of stay among all deliveries complicated by postpartum hemorrhage. We further evaluated compliance with bundle measures for all postpartum hemorrhage cases. Cohort characteristics were compared using chi-square tests or Fisher exact tests for categorical data and Satterthwaite or Wilcoxon 2-sample tests for continuous variables based on data distributions. The proportion of blood product transfusion were evaluated using a chi-square test. A total of 6744 deliveries were included with 3310 in the pre- and 3425 in the postbundle cohort. The prevalence of any blood product transfusion was similar between the pre- and postbundle cohorts (3.41%; 113/3310 vs 3.47%; 119/3425; P=.892). The prevalence of postpartum hemorrhage was 7.05% (233/3310) in the prebundle cohort and 10.34% (354/3434) in the postbundle cohort (P<.001). Among women with postpartum hemorrhage, those in the prebundle cohort had a higher rate of blood product transfusion than those in the postbundle cohort (36.05%; 84/233 vs 26.84%; 95/354; P=.018). Compared with the prebundle counterparts, patients with postpartum hemorrhage in the postbundle cohort had higher rates of utilization of intrauterine balloon placement (10.30%; 24/233 vs 16.95%; 60/354; P=.024). There were no significant differences among other secondary outcomes. The overall compliance with the bundle among those with blood loss ≥1000 mL was 92.1%. The implementation of the postpartum hemorrhage bundle did not decrease the overall prevalence of blood product transfusion and may have led to higher rates of utilization of resources.

Mild thrombocytopenia and the risk for postpartum hemorrhage in twin pregnancies.

We aimed to investigate the association of mild thrombocytopenia with postpartum hemorrhage (PPH) and blood transfusion among women with twin gestations. A retrospective cohort study (Jan 2015 to May 2019) was performed. Women with twin pregnancies and pre-delivery mild thrombocytopenia were compared to those with normal platelet count. The primary outcome was the rate of PPH, defined as a composite of one or more of the following: (1) need for packed red blood cell transfusion; (2) postpartum hemoglobin decline of ≥3g/dL; and (3) the use of postpartum uterotonics agents in addition to oxytocin. Of 1085 women who were included in final analysis, 315 (30.9%) had mild thrombocytopenia (and 770 (69.1%) served as controls. The rate of PPH was increased in the study group (14% vs. 9.4%, P =0.03), as was the use of uterotonic agents (3.8% vs. 1.3%, respectively, P =0.02). The rate of blood product transfusion and hemoglobin decline >3g/dL was not significantly different between the groups. In multivariate logistic regression analysis, mild thrombocytopenia was associated with a higher risk for PPH (OR 1.55 [95% CI 1.02-2.35], P =0.02). Mild thrombocytopenia in twin pregnancies is associated with an increased risk of interventions such as the use of uterotonic agents.

Patterns and Determinants of Blood and Blood Products Transfusion in Neonate: An Experience of Single Institute

BACKGROUND: Neonates requiring intensive care are among the most frequently transfused group of patients. Indications for blood transfusion in neonates could be physiological or pathological. However, despite frequent blood transfusions in neonates in Iraq, there is a paucity of studies on its indications and patterns among neonates in our setting. AIM: The aim of the study is to shed light on the details of giving blood and blood products in the unit of neonate in Children Welfare Teaching hospital, Baghdad and the justifications for giving and its complication. PATIENTS AND METHODS: A descriptive study (cross-section study) includes all neonates admitted to neonatal care unit in Children Welfare Teaching Hospital. The study includes a group of newborns who were blood transfused during their admission to hospital, over a period of 6 months from October 1, 2019 to March 30, 2020. All data were collected from each patient and recorded in predesigned forma, these data include patient’s clinical data and analyzed using descriptive statistics. RESULTS: A total number of cases admitted over a period of 6 months were 862. One hundred and forty neonates received blood and its products transfusion, (61.4%) were male and (38.6%) were female, (62.9%) received packed red blood cells (PRBCs) followed by (18.6%) received exchange transfusion, (11.4%) received Fresh frozen plasma and (7.1%) received platelets. Most neonates received blood products transfused at (3–4) weeks. Post-natal age and were term babies (37–41) weeks. Gestational age mostly received PRBCs. CONCLUSIONS: Most neonates with a high rate of blood and blood product transfusion were males, term, need assistant ventilation, and transfused at 3–4 weeks postnatal age.

Efficacy of Tranexamic Acid in Pediatric Craniofacial and Orthognathic Surgery: A Meta-Analysis

Craniofacial and orthognathic surgery are high risk procedures for surgical blood loss. Significant blood loss leads to increased rates of blood product transfusion which may be associated with increased morbidity to the patient. The use of anti-fibrinolytics such as tranexamic acid has become popular in these procedures. However, the evidence to support its use in pediatric craniofacial and orthognathic surgery is sparse. This review analyzes the current randomized control trials assessing the use of tranexamic acid in craniofacial and orthognathic surgery. The study reviewed published literature up until December 20th, 2020. Six trials were included in this analysis. Pooled data showed that patients who received tranexamic acid during craniofacial or orthognathic surgery have less blood loss compared to those in control groups (mean difference—5.47 ml/kg [CI -7.02-3.82], P value &lt;.05). Hence, rate of blood product transfusion in patients who received tranexamic acid is lower than control group by 2.01 ml/kg (CI 95%, 1.27-2.74, P value &lt;.05). In summary, this review showed that craniofacial and orthognathic surgery patients who receive tranexamic acid might have lower estimated blood loss and receive less volume of blood products transfusion.

Blood Loss and Transfusion in a Pediatric Scoliosis Surgery Cohort in the Antifibrinolytic Era.

Children and adolescents undergoing posterior spinal fusion for scoliosis experience high rates of bleeding and blood product transfusion. Antifibrinolytic therapy is one key strategy to decrease blood loss and transfusion in pediatric scoliosis surgery. Here we review 172 pediatric scoliosis patients (birth to 21 y) who underwent posterior spinal fusion at our institution from 2017 to 2018. We reported rates of blood loss and transfusion, compared patients receiving tranexamic acid to a ε-aminocaproic acid, and evaluated antifibrinolytic agent and laboratory parameters as predictors of blood loss and transfusion. Intraoperatively, 62% received tranexamic acid and 38% received ε-aminocaproic acid. Overall, blood loss (mean intraoperative estimated blood loss=14.9±9.7 mL/kg, 22% with clinically significant blood loss [>20 mL/kg], and mean calculated hemoglobin mass loss=175.9±70.1 g) and transfusion rates (15% with intraoperative allogeneic red blood cell transfusion and mean intraoperative allogeneic red blood cell transfusion volume=12.5±7.1 mL/kg) were similar to previous cohorts studying intraoperative antifibrinolytics. There was no difference in intraoperative estimated blood loss, clinically significant blood loss, calculated hemoglobin mass loss, or transfusion rates between the antifibrinolytic groups. Antifibrinolytic choice was not predictive of blood loss or transfusion. Routine hematologic laboratory parameters and antifibrinolytic choice were insufficient to predict blood loss or other outcomes. Future prospective laboratory-based studies may provide a more comprehensive model of surgical-induced coagulopathy in scoliosis surgery and provide a better tool for predicting blood loss and improving outcomes.

Permanent pacemaker placement following valve surgery is not independently associated with worse outcomes

BackgroundPermanent pacemaker placement (PPM) is associated with morbidity following cardiac surgery. This study identified associations between PPM placement and 5-year outcomes for patients that require PPM following valvular surgery. MethodsAll patients who underwent valvular surgery at our medical center from 2011 to 2018 were considered for analysis. Multivariable analysis identified associations between PPM placement, mortality, and readmissions. Primary outcomes were operative complications and mortality. Secondary outcomes included 5-year survival and readmission. ResultsA total of 175 (4.86%) of 3602 valvular surgery patients required postoperative PPM. The PPM cohort had significantly worse baseline comorbidities, including greater Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores (3.8 vs 2.4 P < .0001). The PPM cohort had greater rates of blood product transfusion, prolonged ventilation, and new-onset atrial fibrillation. PPM placement was significantly associated with third-degree heart block (5.26; 95% confidence interval [95% CI], 1.00-27.53; P = .0496), ventricular fibrillation/tachycardia (3.90; 95% CI, 1.59-9.59; P = .01), and atrial fibrillation/flutter (1.53; 95% CI, 1.05-2.24; P = .03). On Kaplan-Meier estimates, 5-year survival (68.8% vs 83.1%; P = 01) was significantly reduced in the PPM cohort. Five-year all-cause readmission (60.4% vs 50.04%; P = .01) and heart failure readmission (35.5% vs 20.1%; P < .000) occurred more frequently in the PPM cohort. On multivariable Cox regression analysis, PPM placement (hazard ratio, 1.12; 95% CI, 0.84-1.50; P = .444) was not an independent predictor of mortality. On competing risk analysis, PPM (hazard ratio, 1.33; 95% CI, 0.99-1.80; P = .062) was not a predictor of hospital readmission. ConclusionsValvular surgery patients who required postoperative PPM had elevated baseline operative risk. However, PPM implantation was not associated with mortality or readmission.

Metabolik Sendromlu Koroner Baypas Hastalarında Uygulanan İki Farklı Anestezi Tipinin Postoperatif Karaciğer Fonksiyonları Üzerine Etkisi

Objective: One of the factors affecting liver functions in open coronary surgery (CABG) of patients with metabolic syndrome (MS) may be the anesthetic drugs used. For this purpose, we investigated the effects of midazolam-based total intravenous anesthesia (TIVA) and sevoflurane-based inhalation anesthesia on liver functions and postoperative complications in patients with MS who wiould undergo open coronary bypass surgery. Method: A total f 76 patients were included in our study. A statistically significant difference was not found between the TIVA (n=38) and SEVO (n=38) groups in terms of gender, age, body mass index (BMI), Euroscore values, presence of preoperative comorbidity, blood product transfusion, postoperative complications, and 30-day mortality rates. (p&gt;0.05). Preoperative and postoperative laboratory parameters, ALT, AST, LDH, and glucose values were comparable between both groups. Results: 76 patients were included in our study. There was a statistically significant difference between the TIVA (n=38) and SEVO (n=38) groups in terms of gender, age, body mass index (BMI), euroscore values, presence of preoperative comorbidity, blood product transfusion, postoperative complications, and 30-day mortality rates. There was no difference (p&gt;0.05). When compared according to preoperative and postoperative laboratory parameters, ALT, AST, LDH, and glucose values were found similar in both groups. Conclusion: In our study, we found that TIVA and SEVO groups are not superior to each other in coronary bypass patients with metabolic syndrome. Studies investigating detailed parameters with more patients will be guiding for this issue

Efficacy of Intravenous Tranexamic Acid in Reducing Perioperative Blood Loss and Blood Product Transfusion Requirements in Patients Undergoing Multilevel Thoracic and Lumbar Spinal Surgeries: A Retrospective Study.

Introduction: Acute perioperative blood loss is a common and potentially major complication of multilevel spinal surgery, usually worsened by the number of levels fused and of osteotomies performed. Pharmacological approaches to blood conservation during spinal surgery include the use of intravenous tranexamic acid (TXA), an anti-fibrinolytic that has been widely used to reduce blood loss in cardiac and orthopedic surgery. The primary objective of this study was to assess the efficacy of intraoperative TXA in reducing estimated blood loss (EBL) and red blood cell (RBC) transfusion requirements in patients undergoing multilevel spinal fusion. Materials and Methods: This a single-center, retrospective study of subjects who underwent multilevel (≥7) spinal fusion surgery who received (TXA group) or did not receive (control group) IV TXA at The Ohio State University Wexner Medical Center between January 1st, 2016 and November 30th, 2018. Patient demographics, EBL, TXA doses, blood product requirements and postoperative complications were recorded. Results: A total of 76 adult subjects were included, of whom 34 received TXA during surgery (TXA group). The mean fusion length was 12 levels. The mean total loading, maintenance surgery and total dose of IV TXA was 1.5, 2.1 mg per kilo (mg/kg) per hour and 33.8 mg/kg, respectively. The mean EBL in the control was higher than the TXA group, 3,594.1 [2,689.7, 4,298.5] vs. 2,184.2 [1,290.2, 3,078.3] ml. Among all subjects, the mean number of intraoperative RBC and FFP units transfused was significantly higher in the control than in the TXA group. The total mean number of RBC and FFP units transfused in the control group was 8.1 [6.6, 9.7] and 7.7 [6.1, 9.4] compared with 5.1 [3.4, 6.8] and 4.6 [2.8, 6.4], respectively. There were no statistically significant differences in postoperative blood product transfusion rates between both groups. Additionally, there were no significant differences in the incidence of 30-days postoperative complications between both groups. Conclusion: Our results suggest that the prophylactic use of TXA may reduce intraoperative EBL and RBC unit transfusion requirements in patients undergoing multilevel spinal fusion procedures ≥7 levels.

Blood Loss and Transfusion in Pediatric Craniofacial Surgery in the Antifibrinolytic Era

Background : Children undergoing complex cranial vault reconstruction (CCVR) for craniosynostosis experience high rates of bleeding and blood product transfusion, increasing the risk of perioperative complications. The most severe issues relate to the rate and extent of blood loss, which can be up to several times the patient's total blood volume and is often equated to controlled massive hemorrhage. ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are antifibrinolytic agents that have been shown to reduce intraoperative hemorrhage and transfusion requirements during CCVR. However, the relative efficacy of EACA vs. TXA in CCVR has not yet been evaluated. The aim of this study was to compare perioperative blood loss and need for transfusion in children receiving EACA and TXA. We hypothesized that TXA is associated with a greater decrease in blood loss and transfusion requirements when compared to EACA. Methods: All patients who underwent CCVR from September 2015 to December 2019 at our institution were retrospectively evaluated. The primary outcome measures included intraoperative estimated blood loss (EBL), red blood cell (RBC) transfusion volume (mL/kg), and calculated blood loss (CBL) (Kearney et al., Can J Anaesth 1989). Secondary outcome measures included hematologic and coagulation parameters. Study cohort demographic and outcome data were analyzed; Fisher's exact test was used for categorical data, student's t-test was used for continuous data. A p-value of &amp;lt; 0.05 was considered statistically significant. Results: 104 patients were included in the study with 48 patients in the EACA cohort and 56 patients in the TXA cohort. There were slightly more patients with syndromic craniosynostosis in the EACA group, but overall no significant differences in cohort characteristics (Table 1). Mean EBL (mL/kg) was slightly higher in the EACA group vs. the TXA group (21 ± 13 vs. 17 ± 10), but not statistically significant. Intraoperative mean CBL (34 ± 21mL/kg) and intraoperative percent blood volume lost (43 ± 26%) for the cohort were high, but these were equal between groups. Likewise, postoperative DO, CBL and percent blood volume lost were similar between groups. Overall, intraoperative RBC transfusion was required in 66 (64%) of patients and was similar between groups (69% of EACA patients vs. 59% of TXA patients). Intraoperative transfusion of other products was equal between groups. Postoperatively, 23 (22%) of patients required RBC transfusion. Postoperative blood product transfusions were equal between groups (Table 2). We compared routine hematologic and coagulation parameters peri-operatively and did not find any differences between the EACA and TXA group (Table 3). In the EACA group, there were 6 reported perioperative complications, including 2 suspected seizure events, as compared to 7 complications in the TXA group, which included 2 thromboembolic events. Discussion: Pediatric CCVR is a high blood loss surgery and this can lead to a consumptive coagulopathy for which intraoperative antifibrinolytic agents have been demonstrated to improve outcomes. We found no significant difference in blood loss, transfusion requirements, or hematologic parameters between patients who received EACA and TXA in our retrospective pediatric CCVR cohort. Overall there were 4 postoperative outcomes that could have been related to antifibrinolytic use (seizure, thromboembolism), but this was equal between groups and causality was not confirmed. Further research is needed to define optimal antifibrinolytic dosing and duration of therapy. While standard hematologic and coagulation parameters were similar between groups, the mechanisms of surgically induced coagulopathy in CCVR still need to be explored. Future studies investigating coagulation-based and inflammatory assays may be useful in defining surgical-induced coagulopathy. Disclosures No relevant conflicts of interest to declare.

Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis.

Currently, the basis of acute coronary syndrome (ACS) therapy is dual antiplatelet therapy (DAPT) with Aspirin as a nonsteroidal anti-inflammatory drug and clopidogrel as adenosine diphosphate receptor antagonists. Therefore, the aim of the present systematic review is to answer that should DAPT with Aspirin and clopidogrel be continued until coronary artery bypass grafting (CABG) in patients who have ACS? The search for relevant studies in the present meta-analysis is based on three approaches: A) systematic searches in electronic databases, B) manual searches in Google and Google Scholar, and C) screening of bibliography of related original and review articles. The endpoints included mortality rate, myocardial infarction (MI), cerebrovascular accident (CVA), reoperation, re-exploration, other cardiac events, renal failure, length of ICU and hospital stay, chest tube drainage and blood product transfusion after CABG. After the initial screening, 41 articles were studied in detail, and finally the data of 15 studies were included in the meta-analysis. DAPT before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events, but increases reoperation, re-exploration, length of ICU, and hospital stay. Chest tube drainage and blood product transfusion rate significantly increased in the DAPT group compared to the control group (non-antiplatelet or Aspirin alone). Increase in chest tube drainage and blood product transfusion rate indicates an increase in bleeding, so increase in reoperation, re-exploration to control bleeding, and, subsequently, increase in the length of ICU and hospital stay are expected. DAPT with Aspirin and clopidogrel before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events despite more bleedings, and it may be suggested before CABG for better graft patency.

Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery.

Background:Posterior lumbar interbody fusion (PLIF) surgery is associated with significant blood loss; however, few studies have focused on hidden blood loss (HBL) in PLIF or its regulatory factors. The purpose of this study was to explore the HBL in PLIF surgery as well as the influence of tranexamic acid (TXA) on blood loss in PLIF.Methods:We performed a randomized controlled trial (RCT) and recruited patients undergoing PLIF into the study from November 2013 to April 2017. All participants were assigned to one of 2 groups according to a simple equal probability randomization scheme. At the end of PLIF surgery, for patients in the TXA group, the surgical field was immersed in TXA (1 g in 100 mL of saline solution) for 5 min before stitching the wound. For the control group, the surgical field was immersed in the same volume of normal saline.Results:In our study, the drainage volume during the first 24 h and the total postoperative drainage volume were significantly lower in patients in the TXA group than in the control group (P = .001). The hematocrit (Hct) of the drainage and calculation of blood contained in the drainage showed similar results. The mean length of hospital stay and rate of blood transfusion in the TXA group were less than those in the control group (P < .05). HBL was responsible for 45.6% of the total blood loss in PLIF, and both of the indicators in the TXA group were much lower than those in the control group.Conclusions:PLIF is associated with massive perioperative HBL, but the application of topical TXA leads to less postoperative blood loss including less HBL, a lower blood product transfusion rate, and a shorter hospital stay for PLIF.

The use of biological glue (Starsil® Hemostat) in robotic partial nephrectomy: a safety and efficacy study

Introduction: Robotic partial nephrectomy (RPN) is a relatively safe nephron sparing surgery (NSS) approach for the treatment of small renal masses (cT1). However, a major perioperative complication is extensive bleeding and blood loss necessitating blood transfusion. This complication is most challenging during the intraoperative setting and requires proper tumor bed closure. Recently several biological tissue adhesives have been tested to decrease intraoperative bleeding. A novel adhesive, Starsil® Hemostat is a plant-derived polysaccharide that can be applied directly to a bleeding wound to achieve hemostasis. The aim of our current study was to perform an evaluation of the safety and efficacy of this novel hemostat in patients undergoing RPN. Methods: This prospective single arm study included twenty patients with T1a-T1b renal masses who underwent RPN between the years 2017-2018. Renal masses were classified according to size, exophytic/endophytic properties and anatomic location into low, moderate and high complexity cases as described by the R.E.N.A.L nephrometry score. Starsil® Hemostat was applied by a feeding tube through a laparoscopic port after tumor excision. Perioperative data were collected, including blood loss during surgery, blood product transfusion rates, short and long-term adverse events and surgeon satisfaction using a visual analog scale (VAS 1-10). Results: Twenty RPN surgeries were completed using the Starsil® Hemostat. The average age was 61.8 ± 14.3. Average maximal tumor diameter was 3.8 cm (range 1.5-5.7). The calculated mean R.E.N.A.L nephrometry score was 8.4 (range 5-12). Mean blood loss during surgery was 346 mL (range 50-1400 mL). Mean surgeon satisfaction (VAS 1-10) with bleeding control was 8.3, when recorded 24 hours post operation. In 17/20 procedures (85%), bleeding control was good (VAS 9-10) and only 2 patients required blood transfusion. None of the patients developed an allergic reaction. No adverse events related to the adhesive product were noted in the post-surgical follow up period. Conclusion: Tumor bed closure during NSS with the adhesive STARSIL® Hemostat is safe, feasible and easy to use. It has the potential to reduce blood loss and transfusion rate in patients undergoing RPN.

Case Start Time Affects Intraoperative Transfusion Rates in Adult Cardiac Surgery: A Single-Center Retrospective Analysis

The goal of the study was to investigate the role time of day plays in perioperative outcomes. The authors examined intraoperative transfusion rates throughout the day in adult cardiac surgery patients. They hypothesized that the rate of transfusion changes with later case start times in scheduled cardiac surgery. Retrospective observational study. Single academic medical center. Adults undergoing cardiac surgery involving cardiopulmonary bypass. None. The primary outcome was a composite variable of transfusion. The association between the time of day and the rate of transfusion was explored with a multivariate logistic regression to fit the effect of starting time as a cubic spline. There were 1,421 cases that met inclusion criteria. There were 1,220 cases that were matched for modeling. The estimated probability of a patient receiving a transfusion changed significantly with later case start times in the multivariable model after adjusting for initial hemoglobin, age, sex, height, ideal body weight, diabetes, peripheral vascular disease, stroke, chronic kidney disease, chronic obstructive pulmonary disease, duration of cardiopulmonary bypass, aortic cross clamp time, attending surgeon, and attending anesthesiologist (p = 0.032, C-statistic = 0.807, n = 1220). The estimated probability of receiving an intraoperative red blood cell transfusion increased with later case start times in the multivariable model (p = 0.027, C-statistic = 0.902, n = 1220). There was no difference in the probability of transfusion for plasma, cryoprecipitate, or platelets. The observed rate of intraoperative blood product transfusion changed with later case start times in a multivariable model of scheduled cardiac surgery.

Vacuum-assisted venous drainage in adult cardiac surgery: a propensity-matched study.

Conventional cardiopulmonary bypass with gravity drainage leads inevitably to haemodilution. Vacuum-assisted venous drainage (VAVD) utilizes negative pressure in the venous reservoir, allowing active drainage with a shortened venous line to reduce the priming volume. The goal of this study was to analyse the efficacy and safety of VAVD. Data on 19687 patients (18681 with gravity drainage and 1006 with VAVD) who underwent cardiac operations between 1 January 2015 and 31 January 2018 were retrospectively collected from a single centre. Propensity matching identified 1002 matched patient pairs with VAVD and gravity drainage for comparison of blood product transfusion rate, major morbidities and in-hospital mortality rates. The blood transfusion rate of the VAVD group was lower than that of the gravity drainage group (28.1% vs 35% for red blood cells, 13% vs 18% for fresh frozen plasma and 0.1% vs 1.8% for platelets; P = 0.0009, 0.0020 and <0.0001, respectively). The mean difference (95% confidence interval) between the groups for red blood cells, fresh frozen plasma and platelets was -6.9% (-11.0% to -2.8%), -5.0% (-8.1% to -1.8%) and -1.7% (-2.5% to -0.9%), respectively. No difference was observed regarding the major morbidities of cerebrovascular accidents, acute kidney injury, hepatic failure and perioperative myocardial infarction and the in-hospital deaths between the 2 groups. VAVD was associated with a reduction in blood product transfusions, and an increase in the risk of major morbidities and in-hospital deaths of the VAVD group was not observed.