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American Journal of Cardiovascular Drugs

Published in:

01-09-2001 | Therapy in Practice

Transfusion Medicine

Support of Patients Undergoing Cardiac Surgery

Authors: Dr Lawrence T. Goodnough, George J. Despotis

Published in: American Journal of Cardiovascular Drugs | Issue 5/2001

Abstract

There is still no alternative that is as effective or as well tolerated as blood; nevertheless, the search for ways to conserve, and even eliminate blood transfusion, continues.

Based on hemoglobin levels, practice guidelines for the use of perioperative transfusion of red blood cells in patients undergoing coronary artery bypass grafting have been formulated by the National Institutes of Health and the American Society of Anesthesiologists. However, it has been argued that more physiologic indicators of adequacy of oxygen delivery should be used to assess the need for blood transfusion. Methods used for conserving blood during surgery include autologous blood donation, acute normovolemic hemodilution and intra- and postoperative blood recovery and reinfusion. The guidelines for the use of autologous blood transfusion are controversial and it does not appear to be cost effective compared with allogeneic blood transfusion in patients undergoing cardiac surgery. Similarly, the cost effectiveness of intra- and postoperative blood recovery and reinfusion need further evaluation.

Treatment with recombinant human erythropoietin (rhEPO) remains unapproved in the US for patients undergoing cardiac or vascular surgery, but it is a valuable adjunct in Jehovah’s Witness patients, for whom blood is unacceptable. The characterization of darbepoetin alfa, a novel erythropoiesis stimulating protein with a 3-fold greater plasma elimination half-life compared with rhEPO, is an important advance in this field. Darbepoetin alfa appears to be effective in treating the anemia in patients with renal failure or cancer and trials in patients with surgical anemia are planned. Desmopressin has been used to effectively reduce intraoperative blood loss. Topical agents to prevent blood loss, such as fibrin glue and fibrin gel, and agents that alter platelet function, such as aspirin (acetylsalicylic acid) or dipyridamole, need further evaluation in patients undergoing cardiac surgery. Aprotinin has been shown to preserve hemostasis and reduce allogeneic blood exposure to a greater extent than the antifibrinolytic agents tranexamic acid and aminocaproic acid. Controlled clinical trials comparing the costs of these agents with clinical outcomes, along with tolerability profiles in patients at risk for substantial perioperative bleeding are needed.

Goodnough LT, Brecher ME, Kanter MH, et al. Blood transfusion. N Engl J Med 1999; 340: 439–47

Goodnough LT, Brecher ME, Kanter MH, et al. Blood conservation. N Engl J Med 1999; 340: 525–33PubMedCrossRef

Spahn DR, Casutt M. Eliminating blood transfusions. Anesthesiology 2000; 93: 242–55PubMedCrossRef

Glynn SA, Kleinman SH, Schreiber GB, et al. Trends in incidence and prevalence of major transfusion-transmissible viral infections in US blood donors, 1991 to 1996. JAMA 2000; 284: 229–35PubMedCrossRef

Finucane ML, Slovic P, Mertz CK. Public perception of the risk of blood transfusion. Transfusion 2000; 40: 1017–22PubMedCrossRef

Hebert PC, Wells G, Marshall J, et al: Transfusion requirements in critical care. JAMA 1995; 273: 1439–44PubMedCrossRef

Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001; 29: 227–34PubMedCrossRef

Hebert PC, Wells G, Blajchman MA, et al. Transfusion requirements in critical care. A multicenter randomized controlled clinical trial. N Engl J Med 1999; 340: 409–17PubMedCrossRef

Corwin HL, Krantz SB. Anemia of the critically ill: ‘acute’ anemia of chronic disease. Crit Care Med 2000; 28: 3098–9PubMedCrossRef

10.

Van Iperen CE, Gaillard CAJM, Kraaijenhagen RJ, et al. Response of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients. Crit Care Med 2000; 28: 2773–8PubMedCrossRef

11.

Corwin HL, Gettinger A, Rodriguez RM, et al. Efficacy of recombinant human erythropoietin in the critically ill patient: A randomized, double-blind, placebocontrolled trial. Crit Care Med 1999: 27: 246–50CrossRef

12.

Goodnough LT, Johnston MFM, Toy PTCY, et al. The variability of transfusion practice in coronary artery bypass graft surgery. JAMA 1991; 265: 86–90PubMedCrossRef

13.

Surgenor DM, Wallace EL, Churchill WH, et al. Red cell transfusions in coronary artery bypass surgery. Transfusion 1992; 32: 458–64PubMedCrossRef

14.

Stover EP, Siegel LC, Parks R, et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines. Anesthiology 1998; 88: 327–33CrossRef

15.

National Institutes of Health Consensus Conference. Perioperative red cell transfusion. JAMA 1988; 260: 2700–5CrossRef

16.

American Society of Anesthesiologists task force. Practice guidelines for blood component therapy. Anesthesiology 1996; 84: 752–47CrossRef

17.

Goodnough LT, Soegiarso RW, Birkmeyer JD, et al. Economic impact of inappropriate blood transfusions in coronary artery bypass graft surgery. Am J Med 1993; 94: 509–14PubMedCrossRef

18.

Surgenor DM, Churchill WH, Wallace EL. The specific hospital influences red cell and component transfusion in coronary artery bypass graft surgery. A study of five hospitals. Transfusion 1998; 37: 122–34CrossRef

19.

Robertie PG and Gravlee GP. Safe limits of isovolemic hemodilution and recommendations for erythrocyte transfusion. Int Anesthesiol Clin 1990; 28: 197–204PubMedCrossRef

20.

Faust RJ. Perioperative indications for red blood cell transfusion — has the pendulum swung too far? Mayo Clin Proc 1993; 68: 512–4PubMed

21.

Goodnough LT, Despotis GJ, Hogue CW, et al. On the need for improved transfusion indicators in cardiac surgery. Ann Thorac Surg 1995; 60: 473–80PubMedCrossRef

22.

Bryan-Brown CW, Baek SM, Makabali G, et al. Consumable oxygen: Availability of oxygen in relation to oxyhemoglobin dissociation. Crit Care Med 1973; 1: 17–21PubMedCrossRef

23.

Rao TLK, Montoya A. Cardiovascular, electrocardiographic and respiratory changes following acute anemia with volume replacement in patients with coronary artery disease. Anesth Dev 1985; 12: 49–54

24.

Parksloe MRJ, Wuld R, Fox M, et al. Silent myocardial ischemia in a patient with anaemia before operation. Br J Anaesth 1990; 64: 634–7CrossRef

25.

Nelson AH, Fleisher LA, Rosenbaum SH. Relationship between postoperative anemia and cardiac morbidity in high-risk vascular patients in the intensive care unit. Crit Care Med 1993; 21: 860–6PubMedCrossRef

26.

Hogue CW, Goodnough LT, Monk TG. Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy. Transfusion 1998; 38: 924–31PubMedCrossRef

27.

Spiess BD, Ley C, Body SC, et al: Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1998; 116: 460–7PubMedCrossRef

28.

Bracey AW, Radovancevic R, Riggs SA, et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion 1999; 39: 1070–7PubMedCrossRef

29.

Goodnough LT, Vizmeg K, Riddell J, et al. Discharge hematocrit as clinical indicator for blood transfusion audit in surgery patients. Transfus Med 1994; 4: 35–44PubMedCrossRef

30.

Despotis GJ, Grishaber JE, Goodnough LT. The effect of an intraoperative treatment algorithm on physician transfusion behavior in cardiac surgery. Transfusion 1994; 34: 290–6PubMedCrossRef

31.

Despotis GJ, Santoro SA, Spitznagel E, et al. Prospective evaluation and clinical utility of on-site coagulation monitoring in cardiac surgical patients. J Thorac Cardiovasc Surg 1994; 107: 271–9PubMed

32.

Reinersten JL. Algorithms, Guidelines, and Protocols: Can they really improve what we do? Transfusion 1994; 34: 281–2CrossRef

33.

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: 773–81PubMedCrossRef

34.

Sehgal LR, Zebala LP, Takagi I, et al. Evaluation of oxygen extraction ratio as a physiologic transfusion trigger in coronary artery bypass graft surgery patients. Transfusion 2001; 41; 591–5PubMedCrossRef

35.

NHLBI Expert Panel. Transfusion alert: Use of autologous blood. Transfusion 1995; 35: 703–11CrossRef

36.

National Heart, Lung, and Blood Institute Autologous Transfusion Symposium Working Group. Autologous transfusion: Current trends and research issues. Transfusion 1995; 35: 525–31CrossRef

37.

Consensus Conference on Autologous Transfusion. Final consensus statement. Transfusion 1996; 36: 667

38.

British Committee for Standards in Hematology, blood transfusion task force: Guidelines for autologous transfusion. Transfus Med 1993; 307-16

39.

Goodnough LT, Price TH, Rudnick S. Iron restricted erythropoiesis as a limitation to autologous blood donation in the erythropoietin-stimulated bone marrow. J Lab Clin Med 1991; 118: 289–96PubMed

40.

Goodnough LT, Marcus RE. Erythropoiesis in patients stimulated with erythropoietin: The relevance of storage iron. Vox Sang 1998; 75: 128–33PubMedCrossRef

41.

Goodnough LT, Skikne B, Brugnara C. Erythropoietin, iron, and erythropoiesis. Blood 2000; 96: 823–33PubMed

42.

Mann M, Sacks HJ, Goldfinger D. Safety of autologous blood donation prior to elective surgery for a variety of potentially high risk patients. Transfusion 1983; 23: 229–32PubMedCrossRef

43.

Popovsky MA, Whitaker B, Arnold NL. Severe outcomes of allogeneic and autologous blood donation: frequency and characterization. Transfusion 1995; 35:734–7PubMedCrossRef

44.

Birkmeyer JD, Aubuchon JP, Littenberg B, et al. The costs and benefits of preoperative autologous blood donation in elective coronary bypass surgery. Ann Thorac Surg 1994; 57: 161–9PubMedCrossRef

45.

Kruskall MS, Yomtovian R, Dzik WH, et al. On improving the cost-effectiveness of autologous blood transfusion practices. Transfusion 1994; 34: 259–64PubMedCrossRef

46.

Spiess BD, Sassetti R, McCary RJ, et al. Autologous blood donation. Hemodynamics in a high-risk patient population. Transfusion 1992; 32: 17–22PubMedCrossRef

47.

Owings DV, Kruskall MS, Thurer RL, et al. Autologous blood donations prior to elective cardiac surgery. Safety and effect on subsequent blood use. JAMA 1989; 262: 1963–7PubMedCrossRef

48.

Dzik WH, Fleisher AG, Ciavarella D, et al. Safety and efficacy of autologous blood donation before elective aortic valve operation. Ann Thorac Surg 1992; 54: 1177–80PubMedCrossRef

49.

National Blood Resource Education Program Expert Panel. The use of autologous blood. JAMA 1990; 263: 414–7CrossRef

50.

Sazama K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 1990; 30: 583–90PubMedCrossRef

51.

Johnson RG, Thurer RL, Kruskall MS, et al. Comparison of two transfusion strategies after elective operations for myocardial revascularization. J Thorac Cardiovasc Surg 1992; 104: 307–14PubMed

52.

Welch GH, Meehan K, Goodnough LT. Prudent strategies for elective red cell transfusion. Ann Intern Med 1992; 116: 393–403PubMed

53.

Petry AF, Jost T, Sievers H. Reduction of homologous blood requirements by blood pooling at the onset of cardiopulmonary bypass. J Thor Cardiovasc Surg 1994; 107: 1210–4

54.

Mohr R, Martinowitz U, Lavee J, et al. The hemostatic effect of transfusing fresh whole blood versus platelet concentrates after cardiac operations. J Thor Cardiovasc Surg 1988; 96: 530–4

55.

Lavee J, Martinowitz U, Mohr R, et al. The effect of transfusion of fresh whole blood versus platelet concentrates after cardiac operations. J Thorac Cardiovasc Surg 1989; 97: 204–12PubMed

56.

Sowade O, Warneke H, Scigalla P, et al. Avoidance of allogeneic blood transfusions by treatment with recombinant human erythropoietin in patients undergoing open heart surgery. Blood 1997; 89: 411–8PubMed

57.

Robblee JA. Blood harvested before cardiopulmonary bypass decreased postoperative blood loss: Pro. J Cardiothor Anesth 1990; 4: 519–22CrossRef

58.

Starr NJ. Con: Blood should not be harvested immediately before cardiopulmonary bypass and infused after protamine reversal to decrease blood loss following cardiopulmonary bypass. J Cardiothorac Anesth 1990; 4: 522–5PubMedCrossRef

59.

Ray JM, Flynn JC, Bierman AH. Erythrocyte survival following intraoperative autotransfusion in spinal surgery: An in vivo comparative study and 5-year update. Spine 1986; 11: 879–82PubMedCrossRef

60.

Horst HM, Dlugos S, Fath JJ, et al: Coagulopathy and intraoperative blood salvage. J Trauma 1992; 32: 5: 646–53PubMedCrossRef

61.

Despotis GJ, Filos KS, Zoys TN, et al: Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: A multivariate analysis in cardiac surgical patients. Anesth Analg 1996; 82: 13–21PubMed

62.

Boldt J, Zickmann B, Czeke A, et al. Blood conservation techniques and platelet function in cardiac surgery. Anesthesiology 1991; 75: 426–32PubMedCrossRef

63.

Linden JV, Tourault MA, Scribner CL. Decrease in frequency of transfusion fatalities. Transfusion 1997; 37: 243–4PubMedCrossRef

64.

Bell K, Stott K, Sinclair CJ, et al. A controlled trial of intra-operative autologous transfusion in cardiothoracic surgery measuring effect on transfusion requirements and clinical outcome. Transfus Med 1992; 2: 295–300PubMedCrossRef

65.

Goodnough LT, Monk TG, Sicard G, et al. Intraoperative salvage in patients undergoing elective abdominal aortic aneurysm repair. J Vasc Surg 1996; 24: 213–8PubMedCrossRef

66.

Goodnough LT, Bodner MS, Martin JW. Blood transfusion and blood conservation: Cost and utilization issues. Am J Med Qual 1994; 9: 172–83PubMedCrossRef

67.

Elliott MJ. Ultrafiltration and modified ultrafiltration in pediatric open heart operations. Ann Thorac Surg 1993; 56: 1518–22PubMedCrossRef

68.

Naik SK, Knight A, Elliott M. A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 1991; 84: 1181–9

69.

Andreasson S, Gothberg S, Berggren H, et al. Hemofiltration modifies complement activation after extracorporeal circulation in infants. Ann Thorac Surg 1993; 56: 1515–7PubMedCrossRef

70.

Millar AB, Armstrong L, van der Linden J, et al. Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass. Ann Thorac Surg 1993; 56: 1499–502PubMedCrossRef

71.

Journois D, Pouard P, Greeley WJ, et al. Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery. Effects on hemostasis, cytokines, and complement components. Anesthesiology 1994; 81: 1181–9PubMedCrossRef

72.

Schaff HY, Hauer J, Gardner TJ, et al. Routine use of autotransfusion following cardiac surgery: experience in 700 patients. Ann Thorac Surg 1979; 27: 493–9PubMedCrossRef

73.

Cosgrove DM, Loop FD, Lytle BW, et al. Determinants of blood utilization during myocardial revascularization. Ann Thorac Surg 1985; 40: 380–4PubMedCrossRef

74.

Ward HB, Smith RA, Candis KP, et al. A prospective, randomized trial of autotransfusion after routine cardiac surgery. Ann Thorac Surg 1993; 56: 137–41PubMedCrossRef

75.

Thurer RL, Lytle BW, Cosgrove DM, et al. Autotransfusion following cardiac operations: a randomized, prospective study. Ann Thorac Surg 1979; 27: 500–6PubMedCrossRef

76.

Roberts SP, Early GL, Brown B, et al. Autotransfusion of unwashed mediastinal shed blood fails to decrease banked blood requirements in patients undergoing aorta coronary bypass surgery. Am J Surg 1991; 162: 477–80PubMedCrossRef

77.

Schaff HV, Hauer JM, Bell WR, et al. Autotransfusion of shed mediastinal blood after cardiac surgery. A prospective study. J Cardiovasc Thorac Surg 1978; 75: 632–41

78.

Eng J, Kay PH, Murday AJ, et al. Post-operative autologous transfusion in cardiac surgery. A prospective, randomized study. Eur J Cardiothorac Surg 1990; 4: 595–600PubMedCrossRef

79.

Tyson GS, Sladen RN, Spainhour V, et al. Blood conservation in cardiac surgery. Ann Surg 1989; 209: 736–42PubMedCrossRef

80.

Goodnough LT. Blood conservation and blood transfusion practices: Flip sides of the same coin. Ann Thorac Surg 1993; 56: 3–4PubMedCrossRef

81.

Vamvakas EC, Pineda AA. Autologous transfusion and other approaches to reduce allogeneic blood exposure. Baillieres Clin Haematol 2000; 13: 533–47CrossRef

82.

Goodnough LT. The case against universal leukoreduction (and for the practice of evidence-based medicine). Transfusion 2000; 40: 1522–7PubMedCrossRef

83.

Weiskopf RB. Efficacy of acute normovolemic hemodilution assessed as a function of fraction of blood volume lost. Anesthesiology 2001; 94: 439–6PubMedCrossRef

84.

Goodnough LT, Despotis GJ, Merkel K, et al. A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total hip arthroplasty. Transfusion 2000; 40: 1054–7PubMedCrossRef

85.

Toy P, Feiner J, Viele MK, et al. Fatigue during acute isovolemic anemia in healthy, resting humans. Transfusion 2000; 40: 457–60PubMedCrossRef

86.

Lieberman JA, Weiskopf RB, Kelley SD, et al. Critical Oxygen Delivery in Conscious Humans is Less than 7.3 ml O₂ · kg −1 · min −1. Anesthesiology 2000; 92: 406–13CrossRef

87.

Joint Council of the American Red Cross, Council of Community Blood Centers, American Association of Blood Banks. Circular of information for the use of human blood components. 1994 Mar, 9

88.

Goodnough LT, Monk TG, Andriole GL. Erythropoietin therapy. N Engl J Med 1997; 336: 933–8PubMedCrossRef

89.

Goodnough LT, Price TH and the EPO Study Group. A phase III trial of recombinant human erythropoietin therapy in non-anemic orthopaedic patients subjected to aggressive autologous blood phlebotomy: dose, response, toxicity, and efficacy. Transfusion 1994; 34: 66–71PubMedCrossRef

90.

de Andrade JR, Frei D, Guilfoyle M. Integrated analysis of thrombotic/vascular event occurrence in epoietin alfa-treated patients undergoing major, elective ortopedie surgery. Orthopedics 1999; 1 Suppl.: S113–S116

91.

D’Ambra MN, Gray RJ, Hillman R, et al. The effect of recombinant human erythropoietin on transfusion risk in coronary bypass patients. Ann Thorac Surg 1997; 64: 1686–93PubMedCrossRef

92.

Goodnough LT, Despotis GJ, Parvin CA. Erythropoietin therapy in patients undergoing cardiac operations. Ann Thorac Surg 1997; 64: 1579–80PubMedCrossRef

93.

Hutchinson AB, Fergusson D, Graham ID, et al. Utilization of technologies to reduce allogeneic blood transfusion in the United States. Transfus Med 2001; 11:79–85PubMedCrossRef

94.

Marchetta M, Barosi G. Cost-effectiveness of epoietin and autologous blood donation in reducing allogeneic blood transfusions in coronary artery bypass graft surgery. Transfusion 2000; 40: 673–81CrossRef

95.

Brines ML, Ghezzi P, Keenan S, et al. Erythropoietin crosses the blood-brain barrier to protect against experimental brain injury. Proc Nat Acad Sci 2000; 97: 10526–31PubMedCrossRef

96.

Brezden CB, Phillips KA, Abdolell M, et al. Cognitive function in breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 2000; 18: 2695–701PubMed

97.

Egrie JC, Browne JK. Development and characterization of novel erythropoiesis stimulating protein (NESP). Br J Cancer 2001; 84 Suppl. 1: 3–10PubMedCrossRef

98.

Glaspy J, Jadeja JS, Justice G, et al. A dose-finding and safety study of novel erythropoiesis stimulating protein (NESP) for the treatment of anaemia in patients receiving multicycle chemotherapy. Br J Cancer 2001; 84 Suppl. 1:17–23PubMedCrossRef

99.

Smith RE, Jaiyesimi IA, Meza LA, et al. Novel erythropoiesis stimulating protein (NESP) for the treatment of anaemia of chronic disease associated with cancer. Br J Cancer 2001; 84 Suppl. 1: 24–30PubMedCrossRef

100.

Sakariassen KS, Cattaneo M, v. d. Berg A, et al. DDAVP enhances platelet adherence and platelet aggregate growth on human artery subendothelium. Blood 1984; 64: 229–36PubMed

101.

Kanwar S, Woodman RC, Poon MC, et al. Desmopressin induces endothelial P-selectin expression and leukocyte rolling in postcapillary venules. Blood 1995; 86: 2760–6PubMed

102.

Mannucci PM, Remuzzi G, Pusineri F, et al. Deamino-8-D-arginine vasopressin shortens the bleeding time in uremia. N Engl J Med 1983; 308: 8–12PubMedCrossRef

103.

Burroughs AK, Matthews K, Qadiri M, et al. Desmopressin and bleeding time in patients with cirrhosis. BMJ 1985; 291: 1377–81PubMedCrossRef

104.

Kobrinsky NL, Israels ED, Gerrard JM, et al. Shortening of bleeding time by 1-deamino-8-D-arginine vasopressin in various bleeding disorders. Lancet 1984; 1: 1145–48PubMedCrossRef

105.

Salzman EW, Weinstein MJ, Weintraub RM, et al. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double-blind randomized trial. N Engl J Med 1986; 314: 1402–6PubMedCrossRef

106.

Hackmann T, Gascoyne RD, Naiman SC, et al. A trial of desmopressin (1-desamino-8-D-arginine vasopressin) to reduce blood loss in uncomplicated cardiac surgery. N Engl J Med 1989; 321: 1437–43PubMedCrossRef

107.

Lazenby WD, Russo I, Zadeh BJ, et al. Treatment with desmopressin acetate in routine coronary artery bypass surgery to improve postoperative hemostasis. Circulation 1990; 82: IV413–9PubMed

108.

Ansell J, Klassen V, Lew R, et al. Does desmopressin acetate prophylaxis reduce blood loss after valvular heart operations? A randomized, double-blind study. J Thorac Cardiovasc Surg 1992; 104: 117–23PubMed

109.

Casas JI, Zuazu-Jausoro I, Mateo J, et al. Aprotinin versus desmopressin for patients undergoing operations with cardiopulmonary bypass. A double-blind placebo-controlled study. J Thorac Cardiovasc Surg 1995; 110: 1107–17PubMedCrossRef

110.

Temeck BK, Bachenheimer LC, Katz NM, et al. Desmopressin acetate in cardiac surgery: a double-blind, randomized study. South Med J 1994; 87: 611–5PubMedCrossRef

111.

de Prost D, Barbier-Boehm G, Hazebroucq J, et al. Desmopressin has no beneficial effect on excessive postoperative bleeding or blood product requirements associated with cardiopulmonary bypass. Thromb Haemost 1992; 68: 106–10PubMed

112.

Czer LS, Bateman TM, Gray RJ, et al. Treatment of severe platelet dysfunction and hemorrhage after cardiopulmonary bypass: reduction in blood product usage with desmopressin. J Am Coll Cardiol 1987; 9: 1139–47PubMedCrossRef

113.

Mongan PD, Hosking MP. The role of desmopressin acetate in patients undergoing coronary artery bypass surgery. A controlled clinical trial with thromboelastographic risk stratification. Anesthesiology 1992; 77: 38–46PubMedCrossRef

114.

Despotis GJ, Levine V, Saleem R, Spitznagel E, Joist JH,. Use of point of care test in identification of patients who can benefit from desmopressin during cardiac surgery: a randomised, controlled trial. Lancet 1999; 334: 106–10CrossRef

115.

Baker JW, Spotnitz WD, Matthew TL, Fechner RE, Nolan SP. Mediastinal fibrin glue: hemostatic effect and tissue response in calves. Ann Thorac Surg 1989; 47: 450–2PubMedCrossRef

116.

Silberstein LE, Williams LJ, Hughlett MA, et al. An autologous fibrinogen-based adhesive for use in otologic surgery. Transfusion 1988; 28: 319–21PubMedCrossRef

117.

Gibble JW, Ness PM. Fibrin glue: the perfect operative sealant? Transfusion 1990; 30: 741–7PubMedCrossRef

118.

Milde LN. An anaphylactic reaction to fibrin glue. Anesth Analg 1989; 69: 684–6PubMed

119.

Wilson SM, Pell P, Donegan EA. HIV-1 transmission following the use of cryoprecipitated fibrinogen as gel/adhesive [abstract]. Transfusion 1991; 31: 51S

120.

Burnouf-Radosevich M, Burnouf T, Huart JJ. Biochemical and physical properties of a solvent-detergent-treated fibrin glue. Vox Sang 1990; 58: 77–84PubMedCrossRef

121.

Banninger H, Hardegger T, Tobler A, et al. Fibrin glue in surgery: frequent development of inhibitors of bovine thrombin and human factor V. Br J Haematol 1993; 85: 528–32PubMedCrossRef

122.

Teoh KH, Christakis GT, Weisel RD, et al. Blood conservation with membrane oxygenators and dipyridamole. Ann Thorac Surg 1987; 44: 40–7PubMedCrossRef

123.

Fish KJ, Sarnquist FH, van Steennis C, et al. A prospective, randomized study of the effects of prostacyclin on platelets and blood loss during coronary bypass operations. J Thorac Cardiovasc Surg 1986; 91: 436–42PubMed

124.

DiSesa VJ, Huval W, Lelcuk S, et al. Disadvantages of prostacyclin infusion during cardiopulmonary bypass: a double-blind study of 50 patients having coronary revascularization. Ann Thorac Surg 1984; 38: 514–9PubMedCrossRef

125.

Despotis GJ, Hogue CW. Pathophysiology, prevention, and treatment of bleeding after cardiac surgery: A primer for cardiologist and an update for the cardiothoracic team. Am J Cardiol 1999; 83: 15B–30BCrossRef

126.

Horrow JC. Desmopressin and antifibrinolytics [review]. Int Anesthesiol Clin 1990; 28: 230–6PubMedCrossRef

127.

Lambert CJ, Marengo-Rowe AJ, Leveson JE, et al. The treatment of postperfusion bleeding using epsilon-aminocaproic acid, cryoprecipitate, fresh-frozen plasma, and protamine sulfate. Ann Thorac Surg 1979; 28: 440–4PubMedCrossRef

128.

Vander Salm TJ, Ansell JE, Okike ON, et al. The role of epsilon-aminocaproic acid in reducing bleeding after cardiac operation: a double-blind randomized study. J Thorac Cardiovasc Surg 1988; 95: 538–40

129.

Horrow JC, Hlavacek J, Strong MD, et al. Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg 1990; 99: 70–4PubMed

130.

Karski JM, Teasdale SJ, Norman P, et al. Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acid. Double-blind, randomized clinical trial. J Thorac Cardiovasc Surg 1995; 110: 835–42PubMedCrossRef

131.

Ovrum E, Am Holen E, Abdelnoor M, Oystese R, Ringdal ML. Tranexamic acid (Cyklokapron) is not necessary to reduce blood loss after coronary artery bypass operations. J Thorac Cardiovasc Surg 1993; 105: 78–83PubMed

132.

Bidstrup BP, Harrison J, Royston D, et al. Treasure T. Aprotinin therapy in cardiac operations: a report on use in 41 cardiac centers in the United Kingdom. Ann Thorac Surg 1993; 55: 971–6PubMedCrossRef

133.

Fritz H, Wunderer G. Biochemistry and applications of aprotinin, the kallikrein inhibitor from bovine organs. Arzneimittelforschung 1983; 33: 479–94PubMed

134.

Dietrich W, Dilthey G, Spannagl M, et al. Influence of high-dose aprotinin on anticoagulation, heparin requirement, and celite- and kaolin-activated clotting time in heparin-pretreated patients undergoing open-heart surgery. Anesthesiology 1995; 83: 679–89PubMedCrossRef

135.

Marx G, Pokar H, Reuter H, et al. The effects of aprotinin on hemostatic function during cardiac surgery. J Cardiothorac Vasc Anesth 1991; 5: 467–74PubMedCrossRef

136.

Poullis M, Manning R, Laffan M, et al. The anti-thrombotic effect of aprotinin: Actions mediated through the protease-activated receptor 1. J Thorac Cardiovasc Surg 2000; 120: 370–8PubMedCrossRef

137.

Sweeney JD, Blair AJ, Dupuis MP, et al. Aprotinin, cardiac surgery, and factor V Leiden. Transfusion 1997; 37: 1173–8PubMedCrossRef

138.

Lemmer Jr JH, Stanford W, Bonney SL, et al. Aprotinin for coronary bypass operations: efficacy, safety, and influence on early saphenous vein graft patency. A multicenter, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg 1994; 107: 543–53PubMed

139.

Levy JH, Pifarre R, Schaff HV, et al. A multicenter, double-blind, placebo-controlled trial of aprotinin for reducing blood loss and the requirement for donor-blood transfusion in patients undergoing repeat coronary artery bypass grafting. Circulation 1995; 92: 2236–44PubMedCrossRef

140.

Lemmer JH, Dilling EW, Morton JR, et al. Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens. Ann Thorac Surg 1996; 62: 1659–67PubMedCrossRef

141.

Alderman EL, Levy JH, Rick JB, et al. Analyses of coronary graft patency after aprotinin use: results from the international multicenter aprotinin graft patency experience (IMAGE) trial. J Thorac Cardiovasc Surg 1998; 116: 716–30PubMedCrossRef

142.

Slaughter TF, Faghih F, Greenberg CS, et al. The effects of epsilon-aminocaproic acid on fibrinolysis and thrombin generation during cardiac surgery. Anesth Analg 1997; 85: 1221–6PubMed

143.

Montesano RM, Gustafson PA, Palanzo DA, et al. The effect of low-dose epsilonaminocaproic acid on patients following coronary artery bypass surgery. Perfusion 1996; 11: 53–6PubMedCrossRef

144.

Vander Salm TJ, Kaur S, Lancey RA, et al. Reduction of bleeding after heart operations through the prophylactic use of epsilon-aminocaproic acid. J Thorac Cardiovasc Surg 1996; 112: 1098–7CrossRef

145.

Karski JM, Teasdale SJ, Norman PH, et al. Prevention of post-bypass bleeding with tranexamic acid and epsilon-aminocaproic acid. J Cardiothorac Vasc Anesth 1993; 7: 431–5PubMedCrossRef

146.

DelRossi AJ, Cernaianu AC, Botros S, et al. Prophylactic treatment of postperfusion bleeding using EACA. Chest 1989; 96: 27–30CrossRef

147.

McClure PD, Izsak J. The use of epsilo-aminocaproic acid to reduce bleeding during cardiac bypass in children with congenital heart disease. Anesthesiology 1974; 40: 604–8PubMedCrossRef

148.

Midell AI, Hallman GL, Bloodwell RD, et al. Epsilon-aminocaproic acid for bleeding after cardiopulmonary bypass. Ann Thorac Surg 1971; 11: 577–82PubMedCrossRef

149.

Trinh-Duc P, Wintrebert P, Boulfroy D, et al. Comparison of the effects of epsilon-aminocaproic acid and aprotinin on intra- and postoperative bleeding in heart surgery. Ann Chir 1992; 46: 677–83PubMed

150.

de Peppo AP, Pierri MD, Scafuri A, et al. Intraoperative antifibrinolysis and blood-saving techniques in cardiac surgery. Texas Heart Inst J 1995; 22: 231–6

151.

Menichetti A, Tritapepe L, Ruvolo G, et al. Changes in coagulation patterns, blood loss and blood use after cardiopulmonary bypass: aprotinin vs tranexamic acid vs epsilon aminocaproic acid. J Cardiovasc Surg 1996; 37: 401–7

152.

Bennett-Guerrero E, Sorohan JG, Gurevich ML, et al. Cost-benefit and efficacy of aprotinin compared with epsilon- aminocaproic acid in patients having repeated cardiac operations: a randomized, blinded clinical trial. Anesthesiology 1997; 87: 1373–80PubMedCrossRef

153.

Pugh SC, Wielogorski AK. A comparison of the effects of tranexamic acid and low- dose aprotinin on blood loss and homologous blood usage in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1995; 9: 240–4PubMedCrossRef

154.

Blauhut B, Harringer W, Bettelheim P, et al. Comparison of the effects of aprotinin and tranexamic acid on blood loss and related variables after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1994; 108: 1083–91PubMed

155.

Speekenbrink RG, Vonk AB, Wildevuur CR, et al. Hemostatic efficacy of dipyridamole, tranexamic acid, and aprotinin in coronary bypass grafting. Ann Thorac Surg 1995; 59: 438–2PubMedCrossRef

156.

Sundt TM, Kouchoukos NT, Saffitz JE, et al. Renal dysfunction and intravascular coagulation with aprotinin and hypothermie circulatory arrest. Ann Thorac Surg 1993; 55: 1418–24PubMedCrossRef

157.

Cosgrove DM, Heric B, Lytle BW, et al. Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study. Ann Thorac Surg 1992; 54: 1031–8PubMedCrossRef

158.

Westaby S, Katsumata T. Aprotinin and vein graft occlusion-the controversy continues [editorial]. J Thor Cardiovasc Surg 1998; 116: 731–3CrossRef

159.

Smith PK. Aprotinin: Safe and effective only with the full-dose regimen. Ann Thorac Surg 1996; 62: 1575–7PubMedCrossRef

Title: Transfusion Medicine
Support of Patients Undergoing Cardiac Surgery
Authors: Dr Lawrence T. Goodnough
George J. Despotis
Publication date: 01-09-2001
Publisher: Springer International Publishing
Published in: American Journal of Cardiovascular Drugs / Issue 5/2001
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI: https://doi.org/10.2165/00129784-200101050-00004

2024 ASCO Annual Meeting

Springer Medicine

Transfusion Medicine

Support of Patients Undergoing Cardiac Surgery

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

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