Patient Blood Management in der Herzchirurgie

  • P. Meybohm
  • R. M. Muellenbach
  • H. Keller
  • S. Fichtlscherer
  • N. Papadopoulos
  • D. R. Spahn
  • A. Greinacher
  • K. Zacharowski
CME
  • 211 Downloads

Zusammenfassung

Patient Blood Management (PBM) ist ein patientenzentriertes und multidisziplinäres Konzept mit der Zielsetzung, eine Anämie zu vermeiden oder zu therapieren, die Hämostase zu optimieren, den iatrogenen Blutverlust zu minimieren und die Toleranz einer Anämie medizinisch sinnvoll auszunutzen. Der vorliegende CME-Beitrag geht auf besondere Herausforderungen im Bereich der Herzchirurgie ein, u. a. auf das Management der präoperativen Anämie, das präoperative Management von oralen Antikoagulanzien und Thrombozytenaggregationshemmern, das Management der intra- und der postoperativen Koagulopathie, die Vermeidung unnötiger Blutverluste sowie vermeidbare Transfusionen allogener Blutprodukte.

Schlüsselwörter

Anämie Blutverlust Bluttransfusion Hämostase Antikoagulanzien 

Patient blood management in cardiac surgery

Abstract

Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss and medically harness the tolerance to anemia. This continuing medical education (CME) article focusses on the special challenges in patients undergoing cardiac surgery. In particular, management of preoperative anemia, preoperative management of oral anticoagulants and platelet inhibitors, management of intraoperative and postoperative coagulopathy, avoidance of unnecessary blood loss and avoidance of unnecessary transfusion of allogeneic blood products are highlighted.

Keywords

Anemia Blood loss Blood transfusion Hemostasis Anticoagulants 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Meybohm und K. Zacharowski erhielten finanzielle Förderungen von B. Braun Melsungen, CSL Behring, Fresenius Kabi und Vifor Pharma für eine investigatorinitiierte Studie zur Implementierung des PBM-Programms in 4 Universitätsklinika. P. Meybohm und/oder K. Zacharowski erhielten Förderungen oder Reisekostenunterstützung für Beratungen und Vorträge der folgenden Firmen: Abbott GmbH & Co KG, Aesculap Akademie GmbH, AQAI GmbH, Astellas Pharma GmbH, AstraZeneca GmbH, Aventis Pharma GmbH, B. Braun Melsungen AG, Baxter Deutschland GmbH, Biosyn GmbH, Biotest AG, Bristol-Myers Squibb GmbH, CSL Behring GmbH, Dr. F. Köhler Chemie GmbH, Dräger Medical GmbH, Essex Pharma GmbH, Fresenius Kabi GmbH, Fresenius Medical Care, Gambro Hospal GmbH, Gilead, GlaxoSmithKline GmbH, Grünenthal GmbH, Hamilton Medical AG, HCCM Consulting GmbH, Heinen + Löwenstein GmbH, Janssen-Cilag GmbH, med Update GmbH, Medivance EU B.V., MSD Sharp & Dohme GmbH, Novartis Pharma GmbH, Novo Nordisk Pharma GmbH, P. J. Dahlhausen & Co. GmbH, Pfizer Pharma GmbH, Pulsion Medical Systems S.E., Siemens Healthcare, Teleflex Medical GmbH, Teva GmbH, TopMedMedizintechnik GmbH, Verathon Medical, Vifor Pharma GmbH. In den letzten 5 Jahren erhielt D.R. Spahn Förderungen oder Reisekostenunterstützung für Beratungen und Vorträge der folgenden Firmen: Abbott AG, Baar, Schweiz; AMGEN GmbH, München, Deutschland; AstraZeneca AG, Zug, Schweiz; Baxter AG, Volketswil, Schweiz; Baxter S.p.A., Rom, Italien; Bayer, Zürich, Switzerland; Bayer Pharma AG, Berlin, Deutschland; B. Braun Melsungen AG, Melsungen, Deutschland; Boehringer Ingelheim (Schweiz) GmbH, Basel; Bristol-Myers-Squibb, Rueil-Malmaison Cedex, Frankreich, und Baar, Schweiz; CSL Behring GmbH, Hattersheim am Main, Deutschland, und Bern, Schweiz; Curacyte AG, München, Deutschland; Daiichi Sankyo (Schweiz) AG, Thalwil, Schweiz; Ethicon Biosurgery, Sommerville, New Jersey, USA; Fresenius SE, Bad Homburg v.d.H., Deutschland; Galenica AG, Bern, Schweiz (einschließlich Vifor SA, Villars-sur-Glâne, Schweiz); GlaxoSmithKline GmbH & Co. KG, Hamburg, Deutschland; Janssen-Cilag AG, Baar, Schweiz; Janssen-Cilag EMEA, Beerse, Belgien; Merck Sharp & Dohme AG, Luzern, Schweiz; Novo Nordisk A/S, Bagsvärd, Dänemark; Octapharma AG, Lachen, Schweiz; Organon AG, Pfäffikon/SZ, Schweiz; Oxygen Biotherapeutics, Costa Mesa, Kalifornien; PAION Deutschland GmbH, Aachen, Deutschland; Photonics Healthcare B.V., Utrecht, Niederlande; ratiopharm Arzneimittel Vertriebs-GmbH, Vienna, Österreich; Roche Diagnostics International Ltd, Reinach, Schweiz; Roche Pharma (Schweiz) AG, Reinach, Schweiz; Schering-Plough International, Inc., Kenilworth, New Jersey, USA; Tem International GmbH, München, Deutschland; Verum Diagnostica GmbH, München, Deutschland; Vifor Pharma Deutschland GmbH, München, Deutschland; Vifor Pharma Österreich GmbH, Wien, Österreich; Vifor (International) AG, St. Gallen, Schweiz. A. Greinacher war beteiligt an den Zulassungsstudien zu Idarucizumab (Boehringer Ingelheim), ist beteiligt an der Zulassungsstudie von Andexanet Alfa (Portola), leitet eine transfusionsmedizinische Abteilung, die Blutkonserven herstellt und verkauft, und hat Honorare erhalten von GlaxoSmithKline, Bayer, Boehringer Ingelheim, Aspen. R.M. Muellenbach, H. Keller, S. Fichtlscherer und N. Papadopoulos geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Anthes E (2015) Evidence-based medicine: save blood, save lives. Nature 520:24–26PubMedCrossRefGoogle Scholar
  2. 2.
    Rohde JM, Dimcheff DE, Blumberg N et al (2014) Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 311:1317–1326PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    World Health Organization (WHO) (2010) The World Health Assembly. Resolution on availability, safety and quality of blood safety and quality of blood products (WHA 63.12). http://www.who.int/bloodsafety/transfusion_services/self_suff iciency/en/. Zugegriffen: 20. Dez 2014Google Scholar
  4. 4.
    AABB (2015) AABB and the joint commission to partner on patient blood management certification. http://www.aabb.org/press/Pages/pr151203a.aspx. Zugegriffen: 9. Sept 2016Google Scholar
  5. 5.
    AABB (2014) Standards for a patient blood management programGoogle Scholar
  6. 6.
    Kozek-Langenecker S, Bettelheim P, Giurea A et al (2013) Interdisciplinary recommendations for the management of anaemia (patient blood management). http://www.oegari.at/web_files/dateiarchiv/editor/interdisciplinary_recommendations_for_the_management_of_anaemia_2013.pdf. Zugegriffen: 6. Sept 2016Google Scholar
  7. 7.
    National Blood Authority Australia (2013) National patient blood management guidelines implementation strategy 2013–2017. http://www.blood.gov.au/system/files/documents/pbm-guidelines-implementation-strategy-november.pdf. Zugegriffen: 20. Apr 2015Google Scholar
  8. 8.
    National Blood Authority Australia (2016) Patient blood management guidelines. https://www.nba.gov.au/patient-blood-management-pbm. Zugegriffen: 9. Sept 2016Google Scholar
  9. 9.
    NHS Blood and Transplant (2015) Patient blood management. http://hospital.blood.co.uk/patient-services/patient-blood-management/. Zugegriffen: 9. Sept 2016Google Scholar
  10. 10.
    Society for the Advancement of Blood Management (SABM) (2014) SABM administrative and clinical standards for patient blood management programs. https://www.sabm.org/publications. Zugegriffen: 9. Sept 2016Google Scholar
  11. 11.
    Spahn DR, Goodnough LT (2013) Alternatives to blood transfusion. Lancet 381:1855–1865PubMedCrossRefGoogle Scholar
  12. 12.
    Spahn DR, Moch H, Hofmann A et al (2008) Patient blood management: the pragmatic solution for the problems with blood transfusions. Anesthesiology 109:951–953PubMedCrossRefGoogle Scholar
  13. 13.
    Goodnough LT, Maggio P, Hadhazy E et al (2014) Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 54:2753–2759PubMedCrossRefGoogle Scholar
  14. 14.
    Goodnough LT, Shieh L, Hadhazy E et al (2014) Improved blood utilization using real-time clinical decision support. Transfusion 54:1358–1365PubMedCrossRefGoogle Scholar
  15. 15.
    Gross I, Seifert B, Hofmann A et al (2015) Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion 55:1075–1081PubMedCrossRefGoogle Scholar
  16. 16.
    Leahy MF, Roberts H, Mukhtar SA et al (2014) A pragmatic approach to embedding patient blood management in a tertiary hospital. Transfusion 54:1133–1145PubMedCrossRefGoogle Scholar
  17. 17.
    Moskowitz DM, McCullough JN, Shander A et al (2010) The impact of blood conservation on outcomes in cardiac surgery: Is it safe and effective? Ann Thorac Surg 90:451–458PubMedCrossRefGoogle Scholar
  18. 18.
    Oliver JC, Griffin RL, Hannon T et al (2014) The success of our patient blood management program depended on an institution-wide change in transfusion practices. Transfusion 54:2617–2624PubMedCrossRefGoogle Scholar
  19. 19.
    Roubinian NH, Escobar GJ, Liu V et al (2014) Trends in red blood cell transfusion and 30-day mortality among hospitalized patients. Transfusion 54:2678–2686PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Theusinger OM, Kind SL, Seifert B et al (2014) Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland. Blood Transfus 12:195–203PubMedPubMedCentralGoogle Scholar
  21. 21.
    Leahy MF, Hofmann A, Towler S et al (2017) Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 57(6):1347–1358PubMedCrossRefGoogle Scholar
  22. 22.
    Honemann C, Bierbaum M, Heidler J et al (2013) Costs of delivering allogenic blood in hospitals. Chirurg 84:426–432PubMedCrossRefGoogle Scholar
  23. 23.
    Trentino KM, Farmer SL, Swain SG et al (2015) Increased hospital costs associated with red blood cell transfusion. Transfusion 55:1082–1089PubMedCrossRefGoogle Scholar
  24. 24.
    Froessler B, Palm P, Weber I et al (2016) The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg 264:41–46PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Mehra T, Seifert B, Bravo-Reiter S et al (2015) Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs. Transfusion 55:2807–2815PubMedCrossRefGoogle Scholar
  26. 26.
    Fischer DP, Zacharowski KD, Muller MM et al (2015) Patient blood management implementation strategies and their effect on physicians’ risk perception, clinical knowledge and perioperative practice – the Frankfurt experience. Transfus Med Hemother 42:91–97PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Mbanya D (2012) Barriers and enablers to introducing comprehensive patient blood management in the hospital. Biologicals 40:205–208PubMedCrossRefGoogle Scholar
  28. 28.
    Munoz M, Gomez-Ramirez S, Kozek-Langeneker S et al (2015) „Fit to fly“: overcoming barriers to preoperative haemoglobin optimization in surgical patientsdagger. Br J Anaesth 115:15–24PubMedCrossRefGoogle Scholar
  29. 29.
    Vamvakas EC (2013) Reasons for moving toward a patient-centric paradigm of clinical transfusion medicine practice. Transfusion 53:888–901PubMedCrossRefGoogle Scholar
  30. 30.
    National Institute for Health and Care Excellence (NICE) (2017) Quality statement 1: iron supplementation. https://www.nice.org.uk/guidance/qs138/chapter/quality-statement-1-iron-supplementation. Zugegriffen: 18. März 2017Google Scholar
  31. 31.
    Meybohm P, Richards T, Isbister J et al (2017) Patient blood management bundles to facilitate implementation. Transfus Med Rev 31:62–71PubMedCrossRefGoogle Scholar
  32. 32.
    Kulier A, Levin J, Moser R et al (2007) Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 116:471–479PubMedCrossRefGoogle Scholar
  33. 33.
    Loor G, Rajeswaran J, Li L et al (2013) The least of 3 evils: exposure to red blood cell transfusion, anemia, or both? J Thorac Cardiovasc Surg 146(6):1480–1487.e6PubMedCrossRefGoogle Scholar
  34. 34.
    von Heymann C, Kaufner L, Sander M et al (2016) Does the severity of preoperative anemia or blood transfusion have a stronger impact on long-term survival after cardiac surgery? J Thorac Cardiovasc Surg 152:1412–1420CrossRefGoogle Scholar
  35. 35.
    Basora M, Colomina MJ, Tio M et al (2013) Optimizing preoperative haemoglobin with intravenous iron. Br J Anaesth 110:488–490PubMedCrossRefGoogle Scholar
  36. 36.
    Goodnough LT, Maniatis A, Earnshaw P et al (2011) Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth 106:13–22PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Shander A (2014) Preoperative anemia and its management. Transfus Apher Sci 50:13–15PubMedCrossRefGoogle Scholar
  38. 38.
    Spivak JL, Gascon P, Ludwig H (2009) Anemia management in oncology and hematology. Oncologist 14(Suppl 1):43–56PubMedCrossRefGoogle Scholar
  39. 39.
    Theusinger OM, Leyvraz PF, Schanz U et al (2007) Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study. Anesthesiology 107:923–927PubMedCrossRefGoogle Scholar
  40. 40.
    Munoz M, Gomez-Ramirez S, Cuenca J et al (2014) Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion 54:289–299PubMedGoogle Scholar
  41. 41.
    Na HS, Shin SY, Hwang JY et al (2011) Effects of intravenous iron combined with low-dose recombinant human erythropoietin on transfusion requirements in iron-deficient patients undergoing bilateral total knee replacement arthroplasty. Transfusion 51:118–124PubMedCrossRefGoogle Scholar
  42. 42.
    Weltert L, Rondinelli B, Bello R et al (2015) A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion 55:1644–1654PubMedCrossRefGoogle Scholar
  43. 43.
    Yoo YC, Shim JK, Kim JC et al (2011) Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology 115:929–937PubMedCrossRefGoogle Scholar
  44. 44.
    Camaschella C (2015) Iron-deficiency anemia. N Engl J Med 372:1832–1843PubMedCrossRefGoogle Scholar
  45. 45.
    Goodnough LT, Schrier SL (2014) Evaluation and management of anemia in the elderly. Am J Hematol 89:88–96PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Kassebaum NJ, Jasrasaria R, Naghavi M et al (2014) A systematic analysis of global anemia burden from 1990 to 2010. Blood 123:615–624PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352:1011–1023PubMedCrossRefGoogle Scholar
  48. 48.
    Munoz M, Acheson AG, Auerbach M et al (2017) International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 72(2):233–247. doi:10.1111/anae.13773 PubMedCrossRefGoogle Scholar
  49. 49.
    Retter A, Wyncoll D, Pearse R et al (2013) Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol 160:445–464PubMedCrossRefGoogle Scholar
  50. 50.
    Ng O, Keeler BD, Mishra A et al (2015) Iron therapy for pre-operative anaemia. Cochrane Database Syst Rev. doi:10.1002/14651858.cd011588 PubMedCentralGoogle Scholar
  51. 51.
    Avni T, Bieber A, Grossman A et al (2015) The safety of intravenous iron preparations: systematic review and meta-analysis. Mayo Clin Proc 90:12–23PubMedCrossRefGoogle Scholar
  52. 52.
    Geiser P (2009) The pharmacology and safety profile of ferric carboxymaltose (Ferinject®): structure/reactivity relationships of iron preparations. Port J Nephrol Hypert 23:11–16Google Scholar
  53. 53.
    Gasche C, Berstad A, Befrits R et al (2007) Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis 13:1545–1553PubMedCrossRefGoogle Scholar
  54. 54.
    Society of Thoracic Surgeons Blood Conservation Guideline Task F, Ferraris VA, Brown JR et al (2011) 2011 Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91:944–982CrossRefGoogle Scholar
  55. 55.
    Spahn DR (2017) Impact of preoperative treatment of anemia and iron deficiency in cardiac surgery on outcome. https://clinicaltrials.gov/ct2/show/NCT02031289. Zugegriffen: 18. März 2017Google Scholar
  56. 56.
    Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 35(35):2383–2431. doi:10.1093/eurheartj/ehu282 Google Scholar
  57. 57.
    Giebl A, Gurtler K (2014) New oral anticoagulants in perioperative medicine. Anaesthesist 63:347–362 (quiz 363–364)PubMedCrossRefGoogle Scholar
  58. 58.
    Von Heymann C, Kaufner L, Korber M (2014) Perioperative management and therapy of bleeding complications. Anasthesiol Intensivmed Notfallmed Schmerzther 49:196–204 (quiz 205)CrossRefGoogle Scholar
  59. 59.
    Arzneimittelkommission der deutschen Ärzteschaft (AkdÄ) (2016) Orale Antikoagulation bei nicht valvulärem Vorhofflimmern – Empfehlungen zum Einsatz der direkten oralen Antikoagulanzien Dabigatran (Pradaxa®), Apixaban (Eliquis®), Edoxaban (Lixiana®) und Rivaroxaban (Xarelto®), 2. Aufl., S 1–52Google Scholar
  60. 60.
    Gomez-Outes A, Suarez-Gea ML, Lecumberri R et al (2015) Direct-acting oral anticoagulants: pharmacology, indications, management, and future perspectives. Eur J Haematol 95:389–404PubMedCrossRefGoogle Scholar
  61. 61.
    Mar PL, Familtsev D, Ezekowitz MD et al (2016) Periprocedural management of anticoagulation in patients taking novel oral anticoagulants: review of the literature and recommendations for specific populations and procedures. Int J Cardiol 202:578–585PubMedCrossRefGoogle Scholar
  62. 62.
    Roffi M, Patrono C, Collet JP et al (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267–315PubMedCrossRefGoogle Scholar
  63. 63.
    Amour J, Garnier M, Szymezak J et al (2016) Prospective observational study of the effect of dual antiplatelet therapy with tranexamic acid treatment on platelet function and bleeding after cardiac surgery. Br J Anaesth 117:749–757PubMedCrossRefGoogle Scholar
  64. 64.
    Kong R, Trimmings A, Hutchinson N et al (2015) Consensus recommendations for using the Multiplate((R)) for platelet function monitoring before cardiac surgery. Int J Lab Hematol 37:143–147PubMedCrossRefGoogle Scholar
  65. 65.
    Petricevic M, Kopjar T, Biocina B et al (2015) The predictive value of platelet function point-of-care tests for postoperative blood loss and transfusion in routine cardiac surgery: a systematic review. Thorac Cardiovasc Surg 63:2–20PubMedGoogle Scholar
  66. 66.
    Windecker S, Kolh P et al (2014) 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619PubMedCrossRefGoogle Scholar
  67. 67.
    Angiolillo DJ, Firstenberg MS, Price MJ et al (2012) Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA 307:265–274PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Thiele T, Sumnig A, Hron G et al (2012) Platelet transfusion for reversal of dual antiplatelet therapy in patients requiring urgent surgery: a pilot study. J Thromb Haemost 10:968–971PubMedCrossRefGoogle Scholar
  69. 69.
    Vorstand der Bundesärztekammer auf Empfehlung des wissenschaftlichen Beirats (2014) Querschnitts-Leitlinien (BÄK) zur Therapie mit Blutkomponenten und Plasmaderivaten, 4. Aufl.Google Scholar
  70. 70.
    Koch CG, Reineks EZ, Tang AS et al (2015) Contemporary bloodletting in cardiac surgical care. Ann Thorac Surg 99:779–784PubMedCrossRefGoogle Scholar
  71. 71.
    Branco BC, Inaba K, Doughty R et al (2012) The increasing burden of phlebotomy in the development of anaemia and need for blood transfusion amongst trauma patients. Injury 43:78–83PubMedCrossRefGoogle Scholar
  72. 72.
    Lasocki S, Krauspe R, von Heymann C et al (2015) PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol 32:160–167PubMedCrossRefGoogle Scholar
  73. 73.
    Sanchez-Giron F, Alvarez-Mora F (2008) Reduction of blood loss from laboratory testing in hospitalized adult patients using small-volume (pediatric) tubes. Arch Pathol Lab Med 132:1916–1919PubMedGoogle Scholar
  74. 74.
    Hiscock R, Simmons S, Carstensen B et al (2014) Comparison of Massimo Pronto-7 and HemoCue Hb 201+ with laboratory haemoglobin estimation: a clinical study. Anaesth Intensive Care 42:608–613PubMedGoogle Scholar
  75. 75.
    Meybohm P, von Heymann C, Kleinerüschkamp A, Weber C (2015) Patient Blood Management auf der Intensivstation. DIVI 6:158–164Google Scholar
  76. 76.
    Meybohm P, Choorapoikayil S, Wessels A et al (2016) Washed cell salvage in surgical patients: a review and meta-analysis of prospective randomized trials under PRISMA. Medicine (Baltimore) 95:e4490CrossRefGoogle Scholar
  77. 77.
    Varghese R, Myers ML (2010) Blood conservation in cardiac surgery: let’s get restrictive. Semin Thorac Cardiovasc Surg 22:121–126PubMedCrossRefGoogle Scholar
  78. 78.
    Kozek-Langenecker SA, Afshari A, Albaladejo P et al (2013) Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 30:270–382PubMedCrossRefGoogle Scholar
  79. 79.
    Myles PS, Smith JA, Forbes A et al (2017) Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 376:136–148PubMedCrossRefGoogle Scholar
  80. 80.
    Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) (2013) Aprotininhaltige Arzneimittel für die intravenöse Anwendung: Umsetzung des Durchführungsbeschlusses der Kommission. https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RV_STP/a-f/aprotinin.html. Zugegriffen: 17. März 2017Google Scholar
  81. 81.
    Gorlinger K, Shore-Lesserson L, Dirkmann D et al (2013) Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth 27:S20–S34PubMedCrossRefGoogle Scholar
  82. 82.
    Rahe-Meyer N, Solomon C, Hanke A et al (2013) Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial. Anesthesiology 118:40–50PubMedCrossRefGoogle Scholar
  83. 83.
    Bilecen S, De Groot JA, Kalkman CJ et al (2017) Effect of fibrinogen concentrate on Intraoperative blood loss among patients with intraoperative bleeding during high-risk cardiac surgery: a randomized clinical trial. JAMA 317:738–747PubMedCrossRefGoogle Scholar
  84. 84.
    Weber CF, Gorlinger K, Meininger D et al (2012) Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 117:531–547PubMedCrossRefGoogle Scholar
  85. 85.
    Corredor C, Wasowicz M, Karkouti K et al (2015) The role of point-of-care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta-analysis. Anaesthesia 70:715–731PubMedCrossRefGoogle Scholar
  86. 86.
    Wikkelso A, Wetterslev J, Moller AM et al (2016) Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. doi:10.1002/14651858.cd007871.pub3 PubMedGoogle Scholar
  87. 87.
    Lazarus MG, Smul TM, Roewer N et al (2014) Coagulation disorders in the context of cardiac surgery – clinical basics and mechanism based therapy. Anasthesiol Intensivmed Notfallmed Schmerzther 49:50–57 (quiz 58)PubMedCrossRefGoogle Scholar
  88. 88.
    Desborough MJ, Oakland KA, Landoni G et al (2017) Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta-analysis of randomized controlled trials. J Thromb Haemost 15:263–272PubMedCrossRefGoogle Scholar
  89. 89.
    Bilgin YM, Van De Watering LM, Versteegh MI et al (2011) Postoperative complications associated with transfusion of platelets and plasma in cardiac surgery. Transfusion 51:2603–2610PubMedCrossRefGoogle Scholar
  90. 90.
    Aubron C, Flint AW, Bailey M et al (2017) Is platelet transfusion associated with hospital-acquired infections in critically ill patients? Crit Care 21:2PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Agarwal S (2016) Platelet function testing in cardiac surgery. Transfus Med 26:319–329PubMedCrossRefGoogle Scholar
  92. 92.
    Khadzhynov D, Wagner F, Formella S et al (2013) Effective elimination of dabigatran by haemodialysis. A phase I single-centre study in patients with end-stage renal disease. Thromb Haemost 109:596–605PubMedCrossRefGoogle Scholar
  93. 93.
    Denino WF, Carter CB, Sievert A et al (2016) The effect of ultrafiltration with cardiopulmonary bypass on the removal of dabigatran from the circulation of adult pigs. Perfusion 31:424–430PubMedCrossRefGoogle Scholar
  94. 94.
    Habler O, Meier J, Pape A et al (2006) Tolerance to perioperative anemia. Mechanisms, influencing factors and limits. Anaesthesist 55:1142–1156PubMedCrossRefGoogle Scholar
  95. 95.
    Acheson AG, Brookes MJ, Spahn DR (2012) Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg 256:235–244PubMedCrossRefGoogle Scholar
  96. 96.
    Bernard AC, Davenport DL, Chang PK et al (2009) Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 208:931–937PubMedCrossRefGoogle Scholar
  97. 97.
    Glance LG, Dick AW, Mukamel DB et al (2011) Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 114:283–292PubMedCrossRefGoogle Scholar
  98. 98.
    Murphy GJ, Reeves BC, Rogers CA et al (2007) Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116:2544–2552PubMedCrossRefGoogle Scholar
  99. 99.
    Paone G, Likosky DS, Brewer R et al (2014) Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg 97:87–93 (discussion 93–84)PubMedCrossRefGoogle Scholar
  100. 100.
    Horvath KA, Acker MA, Chang H et al (2013) Blood transfusion and infection after cardiac surgery. Ann Thorac Surg 95:2194–2201PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Carson JL, Terrin ML, Noveck H et al (2011) Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 365:2453–2462PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Hebert PC, Wells G, Blajchman MA et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med 340:409–417PubMedCrossRefGoogle Scholar
  103. 103.
    Holst LB, Haase N, Wetterslev J et al (2014) Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 371:1381–1391PubMedCrossRefGoogle Scholar
  104. 104.
    Murphy GJ, Pike K, Rogers CA et al (2015) Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 372:997–1008PubMedCrossRefGoogle Scholar
  105. 105.
    Robertson CS, Hannay HJ, Yamal JM et al (2014) Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 312:36–47PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Villanueva C, Colomo A, Bosch A et al (2013) Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 368:11–21PubMedCrossRefGoogle Scholar
  107. 107.
    American Society of Anesthesiologists Task Force on Perioperative Blood Management (2015) Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists task force on perioperative blood management. Anesthesiology 122:241–275CrossRefGoogle Scholar
  108. 108.
    Carson JL, Grossman BJ, Kleinman S et al (2012) Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med 157:49–58PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • P. Meybohm
    • 1
  • R. M. Muellenbach
    • 2
  • H. Keller
    • 3
  • S. Fichtlscherer
    • 4
  • N. Papadopoulos
    • 3
  • D. R. Spahn
    • 5
  • A. Greinacher
    • 6
  • K. Zacharowski
    • 1
  1. 1.Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieUniversitätsklinikum FrankfurtFrankfurt am MainDeutschland
  2. 2.Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieKlinikum KasselKasselDeutschland
  3. 3.Klinik für Thorax‑, Herz- und Thorakale GefäßchirurgieUniversitätsklinikum FrankfurtFrankfurt am MainDeutschland
  4. 4.Klinik für Kardiologie, Nephrologie und AngiologieUniversitätsklinikum FrankfurtFrankfurt am MainDeutschland
  5. 5.Institut für AnästhesiologieUniversität und Universitätsspital ZürichZürichSchweiz
  6. 6.Institut für Immunologie und TransfusionsmedizinUniversitätsmedizin GreifswaldGreifswaldDeutschland

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