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Perioperative haemostasis and coagulation management in cardiac surgery: a European survey

Published online by Cambridge University Press:  01 June 2007

M. Ranucci
M. Ranucci*
Affiliation:
Cardiothoracic Anaesthesia and Intensive Care Department, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy
*
Correspondence to: Marco Ranucci, Head Cardiothoracic Anesthesia Dept, IRCCS Policlinico S. Donato, Via Morandi 30, 20097 San Donato Milanese, Milan (Italy). E-mail: cardioanestesia@virgilio.it; Tel: +39 02 52774320, Fax: +39 02 55602262
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Summary

Background and objectives

During the last decade many aspects of haemostasis and coagulation management greatly changed in cardiac surgery. On one side, new anti-platelet agents entered the market and became more and more widely used; on the other one, point-of-care monitoring tools are nowadays available for perioperative use. The present survey is aimed to investigate the perioperative haemostasis and coagulation management in European Cardiac Surgery Institutions.

Methods

A questionnaire exploring different aspects of perioperative haemostasis and coagulation management was sent to 320 Cardiac Surgery Institutions in Europe.

Results

82 Institutions replied to the survey. Due to the poor quality of the data collection, 9 Institutions were excluded. A pool of 73 questionnaires coming from 24 different Countries was analyzed. Non-routine coagulation tests (antithrombin activity) are done in 34% of the Institutions before the operation and in 23% after the operation. Point-of-care tests are applied as a preoperative routine in 9.9% of the Institutions (thromboelastography, 5.7%; PFA-100, 1.4%; others, 2.8%) and in selected patients in 50% of the Institutions. Postoperative point-of-care test are applied in 17.9% of the Institutions (thromboelastography, 2.7%; PFA-100, 1.4%; others, 13.8%). Allogeneic blood products use widely differs among Institution: packed red cells are used in 47.5% of the patients (range 8%–90%), fresh frozen plasma in 29% (2%–100%) and platelets in 12.4% (0%–50%).

Conclusions

Perioperative haemostasis and coagulation management is widely different among European Institutions. Point-of-care coagulation and platelet function tests are gaining a significant role. Transfusional policy appears strongly Institution-dependent.

Keywords

CoagulationTransfusionsCardiac surgery
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 1 - 13
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Anderson, EF. Heparin resistance prior to cardiopulmonary bypass. Anesthesiology 1986; 64: 504–507.CrossRefGoogle ScholarPubMed
2.Cloyd, GM, D’Ambra, MN, Akins, CW. Diminished anticoagulant response to heparin in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 1987; 94: 535–538.CrossRefGoogle ScholarPubMed
3.Staples, MH, Dunton, RF, Karlson, KJ, Leonardi, HK, Berger, RL. Heparin resistance after preoperative heparin therapy or intraaortic balloon pumping. Ann Thorac Surg 1994; 57: 1211–1216.CrossRefGoogle ScholarPubMed
4.Dietrich, W, Braun, S, Spannagl, M, Richter, JA. Low preoperative antithrombin activity causes reduced response to heparin in adult but not in infant cardiac-surgical patients. Anesth.Analg 2001; 92: 66–71.CrossRefGoogle Scholar
5.Chan, T, Hwang, NC, Lim, CH. A statistical analysis of factors predisposing patients to heparin resistance. Perfusion 2006; 21: 99–103.CrossRefGoogle Scholar
6.Ranucci, M, Isgro, G, Cazzaniga, A et al. . Different patterns of heparin resistance: therapeutic implications. Perfusion 2002; 17: 199–204.CrossRefGoogle ScholarPubMed
7.Van Norman, GA, Gernsheimer, T, Chandler, WL, Cochran, RP, Spiess, BD. Indicators of fibrinolysis during cardiopulmonary bypass after exogenous antithrombin-III administration for acquired antithrombin III deficiency. J Cardiothorac Vasc Anesth 1997; 11: 760–763.CrossRefGoogle ScholarPubMed
8.Conley, JC, Plunkett, PF. Antithrombin III in cardiac surgery: an outcome study. J Extra Corpor Technol 1998; 30: 178–183.CrossRefGoogle ScholarPubMed
9.Kanbak, M. The treatment of heparin resistance with Antithrombin III in cardiac surgery. Can J Anaesth 1999; 46: 581–585.CrossRefGoogle ScholarPubMed
10.Williams, MR, D’Ambra, AB, Beck, JR et al. . A randomized trial of antithrombin concentrate for treatment of heparin resistance. Ann Thorac Surg 2000; 70: 873–877.CrossRefGoogle ScholarPubMed
11.Heller, EL, Paul, L. Anticoagulation management in a patient with an acquired antithrombin III deficiency. J Extra Corpor Technol 2001; 33: 245–248.CrossRefGoogle Scholar
12.JrLemmer, JH, Despotis, GJ. Antithrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2002; 123: 213–217.CrossRefGoogle ScholarPubMed
13.Levy, JH, Despotis, GJ, Szlam, F et al. . Recombinant human transgenic antithrombin in cardiac surgery: a dose-finding study. Anesthesiology 2002; 96: 1095–1102.CrossRefGoogle ScholarPubMed
14.Koster, A, Fischer, T, Gruendel, M et al. . Management of heparin resistance during cardiopulmonary bypass: the effect of five different anticoagulation strategies on hemostatic activation. J Cardiothorac Vasc Anesth 2003; 17: 171–175.CrossRefGoogle ScholarPubMed
15.Avidan, MS, Levy, JH, Scholz, J et al. . A phase III, double-blind, placebo-controlled, multicenter study on the efficacy of recombinant human antithrombin in heparin-resistant patients scheduled to undergo cardiac surgery necessitating cardiopulmonary bypass. Anesthesiology 2005; 102: 276–284.CrossRefGoogle ScholarPubMed
16.Avidan, MS, Levy, JH, Van Aken, H et al. . Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. J Thorac Cardiovasc Surg 2005; 130: 107–113.CrossRefGoogle ScholarPubMed
17.Ranucci, M, Frigiola, A, Menicanti, L et al. . Postoperative antithrombin levels and outcome in cardiac operations. Crit Care Med 2005; 33: 355–360.CrossRefGoogle ScholarPubMed
18.Sodeck, GH, Schillinger, M, Ehrlich, MP et al. . Preoperative antithrombin III activity predicts outcome after surgical repair of acute type A aortic dissection. Atherosclerosis 2006; 186: 107–112.CrossRefGoogle ScholarPubMed
19.Despotis, GJ, Joist, JH, Goodnough, LT, Santoro, SA, Spitznagel, E. Whole blood heparin concentration measurements by automated protamine titration agree with plasma anti-Xa measurements. J Thorac Cardiovasc Surg 1996; 170: 611–613.Google Scholar
20.Despotis, GJ, Joist, JH, Joiner-Maier, D et al. . Effect of aprotinin on activated clotting time, whole blood and plasma heparin measurements. Ann Thorac Surg 1995; 59: 106–111.CrossRefGoogle ScholarPubMed
21.Hardy, JF, Belisle, S, Robitaille, D et al. . Measurement of heparin concentration in whole blood with the hepcon/HMS device does not agree with laboratory determination of plasma heparin concentration using a chromogenic substrate for activated factor X. J Thorac Cardiovasc Surg 1996; 112: 154–161.CrossRefGoogle Scholar
22.Aldea, GS, O’Gara, P, Shapira, OM et al. . Effect of anticoagulation protocol on outcome in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits. Ann Thorac Surg 1998; 65: 425–433.CrossRefGoogle ScholarPubMed
23.Aldea, GS, Shapira, OM, Treanor, P, Lazar, HL, Shemin, RJ. Effective use of heparin-bonded circuits and lower anticoagulation for coronary artery bypass grafting in Jehovah’s Witnesses. J Cardiac Surg 1996; 11: 12–17.CrossRefGoogle ScholarPubMed
24.Welsby, IJ, Jiao, K, Ortel, TL et al. . The kaolin-activated thrombelastograph predicts bleeding after cardiac surgery. J Cardiothorac Vasc Anesth 2006; 20: 531–535.CrossRefGoogle ScholarPubMed
25.Anderson, L, Quasim, I, Soutar, R, Steven, M, Macfie, A, Korte, W. An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit. Transfus Med 2006; 16: 31–39.CrossRefGoogle Scholar
26.Hertfelder, HJ, Bos, M, Weber, D, Winkler, K, Hanfland, P, Preusse, CJ. Perioperative monitoring of primary and secondary hemostasis in coronary artery bypass grafting. Semin Thromb Hemost 2005; 31: 426–440.CrossRefGoogle ScholarPubMed
27.Shore-Lesserson, L. Evidence based coagulation monitors: heparin monitoring, thromboelastography, and platelet function. Semin Cardiothorac Vasc Anesth 2005; 9: 41–52.CrossRefGoogle ScholarPubMed
28.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: 178–186.CrossRefGoogle ScholarPubMed
29.Fattorutto, M, Pradier, O, Schmartz, D, Ickx, B, Barvais, L. Does the platelet function analyser (PFA-100) predict blood loss after cardiopulmonary bypass? Br J Anaesth 2003; 90: 692–693.CrossRefGoogle ScholarPubMed
30.Habib, RH, Schwann, TA, Zacharias, A, Riordan, CJ. Toward an accurate assessment of the adverse effects of packed red blood cell transfusions in cardiac surgery. Crit Care Med 2006; 34: 3067–3068.CrossRefGoogle ScholarPubMed
31.Basran, S, Frumento, RJ, Cohen, A et al. . The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth Analg 2006; 103: 15–20.CrossRefGoogle ScholarPubMed
32.Shander, A, Moskowitz, D, Rijhwani, TS. The safety and efficacy of “bloodless” cardiac surgery. Semin Cardiothorac Vasc Anesth 2005; 9: 53–63.CrossRefGoogle ScholarPubMed
33.Spiess, BD. Transfusion of blood products affects outcome in cardiac surgery. Semin Cardiothorac Vasc Anesth 2004; 8: 267–281.CrossRefGoogle ScholarPubMed
34.Spiess, BD, Royston, D, Levy, JH et al. . Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes. Transfusion 2004; 44: 1143–1148.CrossRefGoogle ScholarPubMed