Impact of Postoperative Bleeding on Short-Term Outcome in Patients After Orthotopic Heart Transplantation: A Retrospective Cohort Study (original) (raw)
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Anesth Analg. 1996 Jan;82(1):13-21., 1996
The purpose of this study was to prospectively evaluate whether heparin and protamine doses administered using a standardized protocol based on body weight and activated clotting time values are associated with either transfusion of hemostatic blood products (HBPs) or excessive postoperative bleeding. Analysis using 10 multiple logistic or linear regression models in 487 cardiac surgical patients included perioperative variables that may have an association with either transfusion of HBP and/or excessive postoperative chest tube drainage (CTD). Prolonged duration of cardiopulmonary bypass (CPB), lower pre-CPB heparin dose, lower core body temperature in the intensive care unit, combined procedures, older age, repeat procedures, a larger volume of salvaged red cells reinfused intraoperatively and abnormal laboratory coagulation results (prothrombin time, activated partial thromboplastin time, and platelet count) after CPB were associated with both transfusion of HBP and increased CTD. Female gender, lower total heparin dose, preoperative aspirin use and the number of HBPs administered intraoperatively were associated only with increased CTD, whereas a larger total protamine dose was associated only with perioperative transfusion of HBPs. Preoperative use of warfarin or heparin was not associated with excessive blood loss of perioperative transfusion of HBPs. In contrast to previous studies using bovine heparin, data from the present study do not support the use of reduced doses of porcine heparin during CPB.
Predictors of post operative bleeding and blood transfusion in cardiac surgery
Ghana Medical Journal, 2010
In spite of the recent advances in heart surgery, patients undergoing cardiac surgery with cardiopulmonary bypass are at risk of developing significant post-operative bleeding and substantial blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and blood transfusion after heart surgery and offer suggestions on preventive measures. Design and Methods: A prospective analytical study. The perioperative factors studied were haemoglobin level, international normalised ratio (INR), platelet count, and total bypass time. Eighty-seven consecutive patients who underwent heart surgery in the year 2004 were selected. Each patient had laboratory work up which included full blood count, clotting profile, kidney and liver function tests. The total blood loss within the first twenty-four hours and the total units of blood transfused before the patient was discharged were also recorded. Results: Pre-operative haemoglobin was significant in determining the total units of blood received by a patient. Increasing total bypass time caused a significant increase in the percentage reduction of the pre-operative platelet count (p <0.004). However even though there was an increasing trend of post-operative bleeding with increase in total bypass time, this was not significant from the analysis (p<0.069). The percentage reduction in platelet count and immediate postoperative platelet count were significant predictors of postoperative bleeding (p <0 .009) and (p <0.003) respectively. Conclusion: Pre-operative haemoglobin, percentage reduction in the platelet count after cardiopulmonary bypass and immediate postoperative platelet count are significant predictors of postoperative bleeding and blood requirements.
The Annals of Thoracic Surgery, 2011
The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS member or an individual non-member subscription to the journal. R eoperation for bleeding, estimated to occur in 2% to 8% of cardiac surgical patients, is an undesirable event associated with increased patient morbidity, mortality, and resource utilization [1-6]. A recent investigation in coronary artery bypass grafting (CABG) revealed a 2.4% prevalence of reoperation for bleeding with an associated risk-adjusted mortality of 5.9%, compared with 2.0% for patients not returning to the operating room. Not surprisingly, those requiring reoperation received substantially more red blood cell (RBC) transfusions and component therapy [1]. Because of this linkage between reoperation and transfusion requirements, quantifying separate effects on outcomes is challenging. Therefore, primary objectives of this investigation were to determine time-related prevalence of reoperation for bleeding after cardiac surgery, to identify its risk factors, and to assess its association with postoperative morbidity while considering the concomitant risks of transfusion. Our secondary objective was to review source of postoperative bleeding found at reoperation.
Factors Associated with Excessive Postoperative Blood Loss and Hemostatic Transfusion Requirements
Survey of Anesthesiology, 1997
amount of subsequent postoperative CTD or the requirement for hemostatic blood product transfusion when these drugs were administered using a standardized dosing protocol for CPB. Furthermore, this study was designed to examine this issue in conjunction with multiple demographic and perioperative factors using a multivariate statistical analysis involving multiple blood loss and transfusion-related models. Methods After approval by our Institutional Human Studies Committee and obtaining preoperative informed consent, 487 consecutive adult patients undergoing cardiac surgery requiring CPB were prospectively enrolled in this study. Exclusion criteria consisted of: 1) emergency procedures or 2) use of antifibrinolytic drugs (aprotinin, epsilonaminocaproic or tranexamic acid). All patients were anesthetized with fentanyl30-100 pg/kg, supplemented with isoflurance 0.25-0.5 expired minimum alveolar anesthetic concentration, muscle relaxants (vecuronium lo-20 mg pancuronium lo-15 mg, or metocurine 15-20 mg), and
Journal of Cardiothoracic Surgery
Background Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. Objective To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. Methods Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. Results Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk fa...
Transfusion of Blood Products in the Postoperative of Cardiac Surgery
International Journal of Cardiovascular Sciences, 2021
Patients undergoing cardiac surgery are prone to excessive postoperative bleeding. In addition, it is known that the passage of blood through the cardiopulmonary bypass (CPB) circuit triggers the release of inflammatory mediators, resulting in a series of changes in hemostasis. Other situations such as thrombocytopenia, disseminated intravascular coagulation, and liver failure may also influence the occurrence of acute anemia, which should be corrected immediately. 1,2 However, the indiscriminate use of blood products in cardiac surgery has been associated with increased risk of infection, increased need for mechanical ventilation, increased organ failure, longer length of hospital stay, and higher mortality rates. 3-6 Although blood transfusion may become imperative for the management of postoperative cardiac surgery patients, several efforts have been made to restrict and standardize transfusion practice and improve outcomes for patients. 7-9 Much has been discussed about the optimal time for transfusion, although there is no global standardization of hematocrit and hemoglobin values, but only a consensus on clinical criteria. In practice, efforts have focused on maintaining hemoglobin values between 7 and
Revista da Escola de Enfermagem da USP
Objective: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. Method: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. Results: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. Conclusão: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical ...
Comparison of early period results of blood use in open heart surgery
Journal of Research in Medical Sciences, 2016
blood use and to evaluate the patient's blood better. Acute normovolemic hemodilution (ANH) is one of the numerous strategies developed to avoid or, at least, to lower the need for allogeneic blood transfusion (ABT). The known advantages of this method include absence of risk for incompatibility, alloimmunization, immunosuppression, and infection. Moreover, this method provides keeping donor blood for the patients requiring blood transfusion, and also the method is more economic. [2,3] The present study aimed to compare the clinical outcomes of the three approach of blood transfusion. Also, it evaluates the effects of ANH on hemodynamics, tissue oxygenation, need for homologous, and renal and hepatic functions, as well as postoperative complications Background: Various adverse effects of homologous blood transfusion detected particularly in open heart surgery, in which it is frequently used, lead researchers to study on autologous blood use and to evaluate the patient's blood better. Due to the complications of homologous blood transfusion, development of techniques that utilize less transfusion has become inevitable. We aimed to evaluate the effects of acute normovolemic hemodilution (ANH) in patients undergoing open heart surgery. Materials and Methods: In this study, 120 patients who underwent open heart surgery were included. Patients were grouped into three: Autologous transfusion group (Group 1), homologous transfusion group (Group 2), and those received autologous blood and homologous blood products (Group 3). Patient data regarding preoperative characteristics, biochemical parameters, drainage, extubation time, duration of stay at intensive care, atrial fibrillation (AF) development, and hospital stay were recorded. Results: A statistically significant difference (P < 0.005) was found in favor of autologous group (Group 1) with respect to gender, body surface area, European System for Cardiac Operative Risk Evaluation, smoking, hematocrit levels, platelet counts, urea, C-reactive protein levels, protamine use, postoperative drainage, frequency of AF development, intubation period, stay at intensive care and hospital stay, and amount of used blood products. Conclusion: The use of autologous blood rather than homologous transfusion is not only attenuates side effects and complications of transfusion but also positively affects postoperative recovery process. Therefore, ANH can be considered as an easy, effective, and cheap technique during open heart surgery.
Journal of clinical nursing, 2018
To identify factors associated with the increased bleeding in patients during the postoperative period after cardiac surgery. Bleeding is among the most frequent complications that occur in the postoperative period after cardiac surgery, representing one of the major factors in morbidity and mortality. Understanding the factors associated with the increased bleeding may allow nurses to anticipate and prioritise care, thus reducing the mortality associated with this complication. Prospective cohort study. Adult patients in a cardiac hospital who were in the postoperative period following cardiac surgery were included. Factors associated with the increased bleeding were investigated by means of linear regression, considering time intervals of 6 and 12 hr. The sample comprised 391 participants. The factors associated with the increased bleeding in the first 6 hr were male sex, body mass index, cardiopulmonary bypass duration, anoxia duration, metabolic acidosis, higher heart rate, plat...
Revista brasileira de anestesiologia, 2017
Prediction of postoperative excessive blood loss is useful for management of Intensive Care Unit after cardiac surgery. The aim of present study was to examine the effectiveness of International Society on Thrombosis and Hemostasis scoring system in patients with cardiac surgery. After obtaining approval from the institutional review board, the medical records of patients undergoing elective cardiac surgery using Cardio-Pulmonary Bypass between March 2010 and February 2014 were retrospectively reviewed. International Society on Thrombosis and Hemostasis score was calculated in intensive care unit and patients were divided with overt disseminated intravascular coagulation group and non-overt disseminated intravascular coagulation group. To evaluate correlation with estimated blood loss, student t-test and correlation analyses were used. Among 384 patients with cardiac surgery, 70 patients with overt disseminated intravascular coagulation group (n=20) or non-overt disseminated intrava...