Use Of Blood Products In Patients Research Articles

Risk Factors for High Blood Product Use in Patients with Stanford Type A Dissection.

Intraoperative and postoperative bleeding associated with allogeneic blood transfusion and reoperation is still a common and feared complication in patients undergoing surgery due to acute Type A Aortic Dissection (aTAAD). The aim of our study was to identify risk factors for higher transfusion rates. In this retrospective single center study we evaluated pre -, intra-, and postoperative data of 121 patients with aTAAD. Depending on the median of received packed red blood cells (PRBCs), patients were divided into Group A (<8 PRBC, n = 53) and Group B (≥8 PRBC n = 68). Statistical analyses (descriptive statistics, univariable and multivariable logistic regression) were performed using SPSS software 25.0. Statistical significance was assumed at p-value <0.05. A total of 120 patients received a blood product during their perioperative course. Among others we identified age, hemorrhagic pericardial effusion, and dual antiplatelet therapy as preoperative risk factors, low rectal temperature as intraoperative risk factor and low body temperature, positive fluid balance, high lactate level and beginning development of acute renal failure as postoperative risk factors. Our study identifies several factors which predict a higher likelihood of bleeding and consecutive blood transfusion. Knowledge of these factors could influence the therapy to reduce transfusion requirements and lead to a targeted and more efficient use of coagulation products.

Transfusion requirements in cardiac Surgery III (TRICS III), Ticagrelor Substudy

Abstract Background Ticagrelor, in addition to aspirin, has been demonstrated to reduce morbidity and mortality in patients with acute coronary syndrome compared to clopidogrel with aspirin. The treatment effect appeared to be maintained in the subgroup of patients who underwent urgent surgical revascularization. However, the risk of postoperative bleeding in these patients has not been well described. Research question We aimed to establish the effect of ticagrelor exposure within 7 days before surgery on blood loss as measured by postoperative chest tube output and blood product use. Method In a nested cohort study of patients enrolled in the Transfusion Requirements in Cardiac Surgery III (TRICS III) trial, we compared chest tube output and blood product use in patients based on their preoperative exposure to ticagrelor ≤3 days versus &amp;gt;3 days before surgery. Results Of the 5243 patients in TRICS III, 87 patients were exposed to ticagrelor within 7 days with a mean age of 78 years (SD 6) and 74% were male. Patients exposed to ticagrelor 3 days or less before surgery bled a median of 730 ml (IQR 295, 2195) postoperatively in the first 24 hours postoperatively, compared to 518 ml (IQR 350, 1000) for those for whom ticagrelor was held for more than 3 days. We log-transformed the data and found that recent ticagrelor exposure (≤3 days) was associated with significantly more blood loss compared to no exposure for more than 3 days (P-value: 0.01). 69.6% of patients in the recent exposure group received at least one red blood cell transfusion versus 54.7% in patients exposed to ticagrelor more than 3 days pre-operatively (p-value: 0.214). Platelet and fresh frozen plasma transfusion were 52.2% vs 15.6% (p-value 0.001), and 39.1% vs 9.4% (p-value 0.003), respectively, for ticagrelor exposure ≤3 days compared to &amp;gt;3 days. Cryoprecipitate use was 17.4% in the ≤3 days group and 3.1% in the &amp;gt;3 days group (p-value 0.04). Only 1 patient in each group received prothrombin complex concentrate (PCC) transfusion. And 1 patient with exposure ≤3 days received Factor VII. Conclusion Exposure to ticagrelor within 3 days of surgery is associated with an increased risk of postoperative bleeding as assessed by greater chest tube output at 24 hours and more patients requiring blood product transfusion. A ticagrelor-reversing agent may improve the outcomes of patients who have been recently exposed to ticagrelor and require urgent cardiac surgery. Funding Acknowledgement Type of funding source: None

The effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding after emergent isolated coronary artery bypass grafting (CABG) surgery

Aim: Bleeding is a major problem in cardiac surgery, and results in a high risk of allogeneic blood transfusion associated with increased morbidity and mortality. In recent years, studies in the literature reported that desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) reduces the blood loss after surgical interventions. The aim of the present study is to analyze the effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding in patients that were pretreated with P2Y12 inhibitors by cardiologists and undergone emergent coronary artery bypass grafting (CABG) surgery. Material and Methods:The prospectively collected data of 62 adult patients who underwent emergent isolated CABG surgery and pretreated with P2Y12 inhibitors by cardiologists were retrospectively reviewed. The perioperative data of the patients included their demographic data, laboratory findings, the amount of blood loss from chest tubes, the amount of blood product use, need of re-thoracotomy, morbidity and mortality. The patient population was divided into two groups: Group I: Patients that received tranexamic acid and DDAVP perioperatively (n=26); and Group II: Patients that received only tranexamic acid perioperatively (n=36). Results: The two groups of patients had similar characteristics at baseline. There was a statistically significant difference between Group I and II regarding postoperative blood loss from the chest tubes, re-thoracotomy, red blood cell and thrombocyte transfusions (p&amp;lt;0.05). No statistically significant differences were observed between the two groups in terms of fresh frozen plasma transfusion, inotropic support and mortality.Conclusion: We suggest that desmopressin in addition to tranexamic acid reduces bleeding and the amount of blood product use in patients undergoing emergent isolated CABG surgery.

Patterns of blood product use among patients with myelodysplastic syndrome

Most patients with myelodysplastic syndrome (MDS) require blood product support to manage the severe anaemias, which frequently accompany MDS. Our objective was to show the feasibility of linking the Surveillance, Epidemiology and End Results (SEER) database with records from Puget Sound Blood Center (PSBC) to characterize blood product use over time in successive cohorts of patients with MDS. We identified patients with MDS in the SEER registry. The cohort was then linked to PSBC records to discern blood product use. Included in the analysis were 783 patients with MDS entered in the SEER database from 2001 to 2007 for whom data were also available in the PSBC database. Among patients with MDS who received transfusions, 97% received packed red blood cells; 52% received platelets. The proportion of patients with MDS receiving blood products declined from 2001 to 2007. These data show a recent decline in blood product use for patients with MDS. Future studies are needed to further evaluate the reasons for this finding, specifically exploring the impact of newer medications on blood product use in patients with MDS.

Fibrinogen Concentrate Therapy Guided by Thromboelastometry as an Alternative to Fresh Frozen Plasma in Major Vascular Surgery

TYPE IV THORACOABDOMINAL aortic aneurysm (TAAA) repair is a major vascular procedure that involves replacing the native abdominal aorta, from the level of the diaphragm to the aortic bifurcation, with a synthetic graft. During surgery there is a period of complete ischemia of the liver, bowel, and kidneys followed by reperfusion of these organs and a more prolonged period of pelvic and lower limb ischemia. The operation is associated with large blood loss, often exceeding the patient's intravascular volume. Hemostasis usually becomes severely impaired during surgery as the concentrations of fibrinogen, other coagulation factors, and platelets in the patient's blood are decreased by dilution, consumption, hyperfibrinolysis, and the effects of visceral ischemia and reperfusion. 1 Cinà C.S. Clase C.M. Coagulation disorders and blood product use in patients undergoing thoracoabdominal aortic aneurysm repair. Transfus Med Rev. 2005; 19: 143-154 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 2 Gertler J.P. Cambria R.P. Brewster D.C. et al. Coagulation changes during thoracoabdominal aneurysm repair. J Vasc Surg. 1996; 24: 936-943 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar In addition, patients undergoing TAAA repair may be receiving antiplatelet agents, such as aspirin and clopidogrel, and they usually receive anticoagulants, such as heparin, during surgery. In an attempt to correct coagulopathy during surgery, infusions of blood components, such as fresh frozen plasma (FFP) and cryoprecipitate, often are used. However, the efficacy of FFP has been questioned, 3 Stainsby D. Jones H. Asher D. et al. Serious hazards of transfusion: A decade of hemovigilance in the UK. Transfus Med Rev. 2006; 20: 273-282 Abstract Full Text Full Text PDF PubMed Scopus (286) Google Scholar , 4 Stanworth S.J. Brunskill S.J. Hyde C.J. et al. Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol. 2004; 126: 139-152 Crossref PubMed Scopus (347) Google Scholar , 5 Stanworth S.J. Brunskill S.J. Hyde C.J. et al. Appraisal of the evidence for the clinical use of FFP and plasma fractions. Best Pract Res Clin Haematol. 2006; 19: 67-82 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar and the transfusion of allogeneic blood components carries risks, including incompatibility reactions, immunosuppression, transfusion-related acute lung injury and the transmission of bacterial, viral, and prion infections. The UK Government's Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) has recommended that the use of UK-derived FFP should cease because of the concerns regarding variant Creutzfeldt-Jakob disease. 6 Summary of Seventh Meeting of SaBTO (Advisory Committee on the Safety of Blood, Tissues and Organs), July 14/15, 2009. http://www.dh.gov.uk/ab/SaBTO/DH_089412#_2 Google Scholar Cryoprecipitate has been withdrawn from use in many European Union countries and its continued use in the UK is under review by SaBTO. Is It Necessary to Maintain Fibrinogen During Hypothermia and Major Bleeding in Vascular Surgery?Journal of Cardiothoracic and Vascular AnesthesiaVol. 26Issue 5PreviewIn the case reports by Morrison et al,1 3 patients undergoing open thoracoabdominal aneurysm repairs received a continuous infusion of purified human plasma–derived fibrinogen concentrates (CSL Behring, Marburg, Germany) under the guidance of the FIBTEM assay on ROTEM (TEM International, Munich, Germany). There are some concerns about these cases. Full-Text PDF

O-41 Is tranexamic acid useful in patients with low risk for bleeding following cardiac surgery?

Bleeding and inflammation are major complications when the extracorporeal circuit is used. Bleeding is due to multifactorial coagulopathy. Patients who receive preoperative antiplatelets or anticoagulants or have a low haemoglobin (dilutional anaemia) are at increased risk of postoperative bleeding. Use of antifibrinolytic agents reduces the risk of bleeding and decreases the need for blood product use in patients undergoing cardiac surgery. The aim of the study was to determine whether the prophylactic use of the antifibrinolytic, tranexamic acid, is useful in reducing postoperative bleeding and the need for allogeneic transfusion in patients having low risk for bleeding following CABG.

A study of blood product use in patients with major trauma in Scotland: analysis of a major trauma database

Objectives: (1) To define blood product requirements in patients with trauma whose underlying injuries are consistent with major blood loss; (2) to use these data to estimate the annual number...

A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement

The superiority of the left internal mammary artery (LIMA) graft over autogenous saphenous vein as a bypass conduit in coronary artery bypass surgery has been well established. Early and late patency rates of bilateral internal mammary artery (BIMA) grafts exceed those of vein grafts, and patients who receive BIMA have improved long-term survival rates and more freedom from reoperations and other cardiac events. But because of other concerns, particularly the question of increased risk of postoperative bleeding, controversy still surrounds the perioperative period. In the present study we sought to determine whether BIMA grafting was an independent risk factor of postoperative bleeding and of blood product use in patients undergoing primary elective coronary artery revascularization. For this purpose, 33 consecutive patients scheduled for BIMA grafting were matched with 66 patients operated on by single LIMA grafting. Patients in the LIMA group had significantly less postoperative mediastinal drainage than those in the BIMA group (median: 722 vs 920 mL, P = 0.0001). Fifty-six patients received blood products (56% vs 51% in LIMA and BIMA groups, respectively; P = 0.67). In multivariate analysis, BIMA and operative duration were independent predictors of increased postoperative drainage. Nevertheless, in logistic regression, BIMA was not significantly associated with blood product use, unlike precardiopulmonary bypass hematocrit and duration of surgery (OR and 95% CI: 0.89 [0.80-0.96] P = 0.01; 1.009 [1.001-1.019] P = 0.04, for an increase of 1% in hematocrit and 1 min in duration of surgery, respectively). In conclusion, these data support the idea that BIMA graft slightly increases postoperative drainage but not transfusion requirement.

Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: A prospective randomized controlled clinical trial

Use of antifibrinolytic agents reduces the risk of bleeding and decreases the need for blood product use in patients undergoing cardiac surgery. The purpose of this study was to determine whether perioperative use of tranexamic acid decreases the rate of saphenous vein graft patency in the early postoperative period after conventional coronary artery bypass grafting surgery. A total of 312 patients scheduled for elective coronary artery bypass grafting surgery with cardiopulmonary bypass were randomized to receive either tranexamic acid 100 mg/kg (n = 147) or placebo (n = 165) in a double-blinded fashion before the initiation of cardiopulmonary bypass. Saphenous vein graft patency was assessed with magnetic resonance imaging 5 to 30 days after surgery. Both groups were comparable with respect to baseline demographic data and surgical characteristics. A total of 237 (76%) patients underwent magnetic resonance imaging assessment. A total of 297 saphenous vein grafts were performed and 253 (85.2%; 95% confidence interval, 83.5%-86.9%) were seen in the tranexamic acid group, and 265 saphenous vein grafts were performed and 231 (87.2%; 95% confidence interval, 85.5%-88.9%) were seen in the placebo group (P = .4969). The blood loss and blood product transfusion rates in the tranexamic acid group were significantly lower than in the placebo group. There was no difference between groups with respect to postoperative morbidity and mortality. The administration of tranexamic acid before cardiopulmonary bypass did not seem to compromise early venous graft patency rates but reduced perioperative blood product transfusion rates. Consequently, tranexamic acid could be advocated for routine use in patients undergoing conventional coronary artery bypass grafting surgery.

???Low-Dose??? Recombinant Activated Factor VII Results in Less Blood and Blood Product Use in Traumatic Hemorrhage

This study was designed to compare mortality and blood product use in patients who received recombinant activated factor VII (rFVIIa) for traumatic hemorrhage to a matched historic control. Trauma registry data of bleeding trauma patients who received rFVIIa (40 microg/kg, repeated once if needed) included 28-day mortality; pre- and post-rFVIIa international normalized ratio; and packed red blood cell (PRBC), fresh frozen plasma, platelet, and cryoprecipitate requirements. A control group was created of bleeding patients who did not receive rFVIIa by matching for Injury Severity Score and age. The chi2 and Student's t tests were used to test for significance. Twenty-nine patients, well matched to 72 control patients, made up the rFVIIa group. rFVIIa corrected international normalized ratio within 4 hours (from 4.4 to 1.2; p < 0.0001). There was no difference in mortality (control, 40.3%; rFVIIa, 41.4%). The rFVIIa group required significantly fewer PRBC transfusions than the control group (18.3 +/- 7.5 vs. 22.0 +/- 9.7; p = 0.036). Compared with the control group, the rFVIIa group required fewer platelet transfusions (1.4 +/- 1.2 vs. 2.3 +/- 2.1; p = 0.01) and less cryoprecipitate (0.59 +/- 0.54 vs. 1.5 +/- 1.8; p = 0.006). rFVIIa resulted in significantly less PRBC, platelet, and cryoprecipitate use and equivalent mortality when compared with the matched control group, with no increase in complications.

Identifying Patients at Risk of Intraoperative and Postoperative Transfusion in Isolated CABG: Toward Selective Conservation Strategies

Background Allogeneic blood product use during cardiac operation is often reported to exceed 40% despite published guidelines and costly blood conservation strategies. We developed a predictive model, based on eight preoperative risk factors, of allogeneic blood product transfusion rates in patients undergoing a cardiac procedure. Methods All 3,046 consecutive, isolated coronary artery bypass graft (CABG) procedures at a university hospital from 1995 to 1998 were included. A logistic regression model was created to identify independent predictors of allogeneic blood product transfusion. This model was validated using a prospective patient sample. Results Overall use of allogeneic blood products was 23% with a crude operative mortality of 2.1%. In isolated, elective, first-time CABG cases, 16.9% received allogeneic blood products. Independent predictors of blood product usage in CABG patients were preoperative hemoglobin 12.0 or less, emergent operation, renal failure, female sex, age 70 years or older, left ventricular ejection fraction 0.40 or less, redo procedure, and low body surface area. Prospective validation of this model on 2,117 consecutive isolated CABG patients demonstrated an observed-to-expected allogeneic blood product transfusion rate ratio of 1.06. Conclusions This internally validated logistic regression risk model is a sensitive and specific predictor of allogeneic blood product use in patients undergoing isolated CABG. Utilization of this model allows for preoperative risk stratification and may allow for more rational resource allocation of costly blood conservation strategies and blood bank resources.

Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: A prospective, randomized, double-blind, placebo-controlled trial

Background: Although low-dose aprotinin administered after cardiopulmonary bypass has been reported to reduce mediastinal blood loss and blood product requirements in patients not taking aspirin, it is unknown whether low-dose postoperative aprotinin has any beneficial effects in patients undergoing coronary artery bypass operations who are at high risk of excessive postoperative bleeding and increased transfusion requirements because of aspirin use until just before the operation. Methods: Fifty-five patients undergoing primary coronary artery operations with cardiopulmonary bypass who continued taking aspirin (150 mg/d) until the day before the operation were enrolled in a prospective, randomized, double-blind trial to receive a single dose of either placebo (n = 29) or 2 × 10 6 kallikrein inhibiting units of aprotinin (n = 26) at the time of sternal skin closure. Results: Patients in the aprotinin group had a lower rate (28 ± 18 vs 43 ± 21 mL/h [mean ± standard deviation], P < .005) and total volume of mediastinal drainage (955 ± 615 vs 1570 ± 955 mL, P < .007), as well as a shorter duration of mediastinal drain tube insertion (24.4 ± 13.8 vs 31.3 ± 16.5 hours, P < .05). In addition, a smaller proportion of patients receiving aprotinin required a blood product (31% vs 62%, P = .03), resulting in a reduction in the use of packed cells by 47% ( P = .05), platelets by 77% ( P = .01), fresh frozen plasma by 88% ( P = .03), and total blood products by 68% ( P = .01) in this group. Conclusions: These results suggest that postoperative administration of low-dose aprotinin in patients taking aspirin until just before primary coronary artery operations with cardiopulmonary bypass not only reduces the rate and total amount of postoperative mediastinal blood loss but also lowers postoperative blood product use.