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Treatment Algorithms for Bleeding

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Patient Blood Management in Cardiac Surgery

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Abstract

Patient blood management in cardiac surgery consists of multiple steps aiming for prevention, diagnosis, and treatment of bleeding. The treatment of microvascular bleeding, in particular with the support of point-of-care viscoelastic hemostatic testing, contributes to reduced bleeding volumes and blood transfusion requirements. There are numerous treatment algorithms available for microvascular bleeding, all with added value for clinical daily practice in cardiac surgery. The specific algorithm that is implemented in an individual institution depends on the available diagnostic methods and the treatment options.

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References

  1. Dyke C, Aronson S, Dietrich W, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147:1458–63.

    Article  Google Scholar 

  2. Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol. 2017;34:332–95.

    Article  Google Scholar 

  3. Boer C, Meesters MI, Milojevic M, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018;32:88–120.

    Article  CAS  Google Scholar 

  4. Karkouti K, Callum J, Wijeysundera DN, et al. Point-of-care hemostatic testing in cardiac surgery: a stepped-wedge clustered randomized controlled trial. Circulation. 2016;134:1152–62.

    Article  Google Scholar 

  5. Weber CF, Görlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012;117:531–47.

    Article  Google Scholar 

  6. Girdauskas E, Kempfert J, Kuntze T, et al. Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. J Thorac Cardiovasc Surg. 2010;140:1117–24.

    Article  Google Scholar 

  7. Westbrook AJ, Olsen J, Bailey M, Bates J, Scully M, Salamonsen RF. Protocol based on thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study. Heart Lung Circ. 2009;18:277–88.

    Article  Google Scholar 

  8. Ak K, Isbir CS, Tetik S, et al. Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study. J Card Surg. 2009;24:404–10.

    Article  Google Scholar 

  9. Kultufan Turan S, Aydinli B, Ayik I, et al. The role of rotational thromboelastography on decision of blood transfusion in open heart surgery. Anest Yog Bak Dern Deg. 2006;12:154–9.

    Google Scholar 

  10. Avidan MS, Alcock EL, Da Fonseca J, et al. Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery. Br J Anaesth. 2004;92:178–86.

    Article  CAS  Google Scholar 

  11. Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology. 2001;94:773–81.

    Article  CAS  Google Scholar 

  12. Royston D, von Kier S. Reduced haemostatic factor transfusion using heparinase-modified thromboelastography during cardiopulmonary bypass. Br J Anaesth. 2001;86:575–8.

    Article  CAS  Google Scholar 

  13. Shore-Lesserson L, Manspeizer HE, DePerio M, et al. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg. 1999;88:312–9.

    CAS  PubMed  Google Scholar 

  14. Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res. 2016;203:424–33.

    Article  Google Scholar 

  15. Serraino GF, Murphy GJ. Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis. Br J Anaesth. 2017;118:823–33.

    Article  CAS  Google Scholar 

  16. Rahe-Meyer N, Levy JH, Mazer CD, et al. Randomized evaluation of fibrinogen vs placebo in complex cardiovascular surgery (REPLACE): a double-blind phase III study of haemostatic therapy. Br J Anaesth. 2016;117:41–51.

    Article  CAS  Google Scholar 

  17. Görlinger K, Dirkmann D, Hanke AA. Potential value of transfusion protocols in cardiac surgery. Curr Opin Anaesthesiol. 2013;26:230–43.

    Article  Google Scholar 

  18. Haas T, Görlinger K, Grassetto A, Agostini V, Simioni P, Nardi G, Ranucci M. Thromboelastometry for guiding bleeding management of the critically ill patient: a systematic review of the literature. Minerva Anestesiol. 2014;80:1320–35.

    CAS  PubMed  Google Scholar 

  19. Görlinger K, Shore-Lesserson L, Dirkmann D, Hanke AA, Rahe-Meyer N, Tanaka KA. Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth. 2013;27:S20–34.

    Article  Google Scholar 

  20. Ranucci M, Pistuddi V, Di Dedda U, Menicanti L, de Vincentiis C, Baryshnikova E. Platelet function after cardiac surgery and its association with severe postoperative bleeding: the platform study. Platelets. 2018:1–7 [Epub Ahead of Print].

    Google Scholar 

  21. Solomon C, Ranucci M, Hochleitner G, Schöchl H, Schlimp CJ. Assessing the methodology for calculating platelet contribution to clot strength (platelet component) in thromboelastometry and thrombelastography. Anesth Analg. 2015;121:868–78.

    Article  Google Scholar 

  22. Rahe-Meyer N, Solomon C, Hanke A, et al. Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery. Anesthesiology. 2013;118:40–50.

    Article  CAS  Google Scholar 

  23. Görlinger K, Dirkmann D, Hanke AA, Kamler M, Kottenberg E, Thielmann M, Jakob H, Peters J. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology. 2011;115:1179–91.

    Google Scholar 

  24. Solomon C, Schöchl H, Hanke A, Calatzis A, Hagl C, Tanaka K, Rahe-Meyer N. Haemostatic therapy in coronary artery bypass graft patients with decreased platelet function: comparison of fibrinogen concentrate with allogeneic blood products. Scand J Clin Lab Invest. 2012;72:121–8.

    Article  CAS  Google Scholar 

  25. Agarwal S, Johnson RI, Shaw M. Preoperative point-of-care platelet function testing in cardiac surgery. J Cardiothorac Vasc Anesth. 2015;29:333–41.

    Article  Google Scholar 

  26. Agarwal S, Johnson RI, Shaw M. A comparison of fibrinogen measurement using TEG(¬Æ) functional fibrinogen and Clauss in cardiac surgery patients. Int J Lab Hematol. 2015;37:459–65.

    Article  CAS  Google Scholar 

  27. Ranucci M, Pistuddi V, Baryshnikova E, Colella D, Bianchi P. Fibrinogen levels after cardiac surgical procedures: association with postoperative bleeding, trigger values, and target values. Ann Thorac Surg. 2016;102:78–85.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, Istituto Policlinico San Donato, Milan, Italy

    Marco Ranucci

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  1. Marco Ranucci
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Correspondence to Marco Ranucci .

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Editors and Affiliations

  1. Vivantes Klinikum im Friedrichshain, Berlin, Germany

    Christian von Heymann

  2. Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands

    Christa Boer

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Ranucci, M. (2019). Treatment Algorithms for Bleeding. In: von Heymann, C., Boer, C. (eds) Patient Blood Management in Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-15342-7_18

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  • DOI: https://doi.org/10.1007/978-3-030-15342-7_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15341-0

  • Online ISBN: 978-3-030-15342-7

  • eBook Packages: MedicineMedicine (R0)

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