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29-12-2011 | Surgery | Article

Treatment algorithm reduces blood transfusions during CV surgery


Free abstract

MedWire News: Research shows that a treatment algorithm consisting of first-line administration of coagulation factor concentrates combined with point-of-care (POC) coagulation testing reduces the incidence of allogeneic blood transfusions in cardiovascular (CV) patients.

The use of blood transfusions in patients, including CV patients, is associated with increased morbidity and mortality, as well as prolonged hospital stays and increased hospital costs.

Several studies have suggested that implementation of POC coagulation tests in addition to treatment algorithms decreases transfusion requirements. However, these studies were small and varied greatly in the POC measurements performed and coagulation factor concentrates used.

In the current retrospective, single-center, cohort study Klaus Görlinger (Universitätsklinikum Essen, Germany) and colleagues analyzed the incidence of intraoperative allogeneic blood transfusion before and after implementation of a treatment algorithm.

The study cohort consisted of 3865 patients, with 1718 undergoing surgery prior to algorithm implementation, and 2147 following implementation. The patients undergoing surgery post algorithm implementation were significantly older (66.4 vs 64.4 years), using more dual antiplatelet therapy (13.7 vs 2.7%), and had more emergency surgeries (10.5 vs 7.5%) compared with the pre-algorithm patients.

Following algorithm implementation there was a significant decrease in the incidence of any allogeneic blood transfusion (52.5 vs 42.2%), and in the use of packed red blood cells (49.7 vs 40.4%) or fresh frozen plasma (19.4 vs 1.1%). In addition, the incidence of massive transfusion (10 U packed red blood cells or more) significantly decreased from 2.50% to 1.26%, and that of unplanned re-explorations from 4.19% to 2.24%.

The occurrence of thrombotic or thromboembolic events also significantly decreased (3.19 vs 1.77%), but there was no impact on in-hospital mortality (5.24 vs 5.22%).

Reporting in the journal Anesthesiology, the authors conclude that these data "demonstrate that implementation of a coagulation management algorithm based on first-line therapy with specific coagulation factor concentrates combined with POC testing was associated with significantly and substantially decreased allogeneic blood transfusion incidence."

"This was despite a patient population that was sicker and more likely to bleed. Furthermore, the incidence of massive transfusion, re-exploration, and of thrombotic/thromboembolic adverse events also decreased."

By Iain Bartlett

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