nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

01.04.2013 | Reports of Original Investigations

The rationale for platelet transfusion during cardiopulmonary bypass: an observational study

verfasst von: Nusrat Zaffar, Ashley Joseph, C. David Mazer, MD, Rosane Nisenbaum, PhD, Keyvan Karkouti, MD, Alan Tinmouth, MD, Mark D. Peterson, MD, Katerina Pavenski, MD, Jeannie Callum, MD, Christine Cserti-Gazdewich, MD, Nadine Shehata, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 4/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Platelet transfusion in cardiac surgery is often empiric as no established point-of-care tests are available for clear guidance of blood product administration, and there are many variables that can potentially increase the risk of bleeding during cardiopulmonary bypass. The objectives of this study were to determine the factors that influenced physicians’ decisions to transfuse platelets perioperatively and to determine whether these factors coincide with characteristics using chart abstraction.

Methods

This study was conducted at three university affiliated hospitals using focused physician questionnaires to assess factors influencing decisions to transfuse platelets and data abstraction to determine characteristics of patients receiving platelet transfusion during cardiac surgery.

Results

Seventy-six physicians participated in the questionnaire; 41% identified bleeding and 22% identified both bleeding and the platelet count as the most significant factors influencing their decision to transfuse platelets. Of the 629 patients included in the study, 24.5% received a platelet transfusion intraoperatively and 4.5% received the transfusion postoperatively. The following factors were identified with the highest odds of receiving a platelet transfusion intraoperatively: combined bypass and valvular surgery (odds ratio [OR] 3.94; 95% confidence interval [CI] 1.94 to 8.00) and the presence of liver disease (OR 6.43; 95% CI 1.17 to 35.37).

Conclusion

The use of focused physician questionnaires identified relevant aspects of patient care not apparent in the chart review that influenced the decision to transfuse platelets. The identification of bleeding, thrombocytopenia, more complex surgery, and the presence of liver disease highlights the requirement for standardized measures to assess the need for platelet transfusions in bleeding patients.

Nur mit Berechtigung zugänglich

Harker LA, Malpass TW, Branson HE, Hessel EA 2nd, Slichter SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective alpha-granule release. Blood 1980; 56: 824-34.PubMed

Desposits G, Eby C, Lublin DM. A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery. Transfusion 2008; 48(1 Suppl): 2S-30S.

Cobain TJ, Vamvakas EC, Wells A, Titlestad K. A survey of the demographics of blood use. Transfus Med 2007; 17: 1-15.PubMedCrossRef

Snyder-Ramos SA, Mohnle P, Weng YS, et al.; Investigators of the Multicenter Study of Perioperative Ischemia; MCSPI Research Group. The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion 2008; 48: 1284-99.

Surgenor DM, Churchil WH, Wallace EL, et al. Determinants of red cell, platelet, plasma, and cryoprecipitate transfusions during coronary artery bypass graft surgery: the Collaborative Hospital Transfusion Study. Transfusion 1996; 36: 521-32.PubMedCrossRef

Karkouti K, Wijeysundera DN, Yau TM, et al. Platelet transfusions are not associated with increased morbidity or mortality in cardiac surgery. Can J Anesth 2006; 53: 279-87.PubMedCrossRef

Bracey AW, Radovancevic R, Radovancevic B, McAllister HA Jr, Vaughn WK, Cooley DA. Blood use in patients undergoing repeat coronary artery bypass graft procedures: multivariate analysis. Transfusion 1995; 35: 850-4.PubMedCrossRef

Bennett-Guerrero E, Zhao Y, O’Brien SM, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA 2010; 304: 1568-75.PubMedCrossRef

O’Brien SF, Yi QL, Fan W, Scalia V, Fearon MA, Allain JP. Current incidence and residual risk of HIV, HBV and HCV at Canadian Blood Services. Vox Sang 2012; 103: 83-6.PubMedCrossRef

10.

Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113: 3406-17.PubMedCrossRef

11.

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: 1143-8.PubMedCrossRef

12.

Covin R, O’Brien M, Grunwald G, et al. Factors affecting transfusion of fresh frozen plasma, platelets, and red blood cells during elective coronary artery bypass graft surgery. Arch Pathol Lab Med 2003; 127: 415-23.PubMed

13.

Ray JG, Deniz S, Olivieri A, et al. Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel. BMC Cardiovasc Disord 2003; 3: 3.PubMedCrossRef

14.

Gravlee GP, Davis RF, Kurusz M, Utley JR. Cardiopulmonary Bypass: Principles and Practice. Philadelphia: Lippincott Williams & Wilkins; 2000.

15.

Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987; 40: 373-83.PubMedCrossRef

16.

Enriquez LJ, Shore-Lesserson L. Point-of-care coagulation testing and transfusion algorithms. Br J Anaesth 2009; 103(Suppl 1): i14-22.PubMedCrossRef

17.

Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP et al.; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Spiess BD, Shore-Lesserson L, Stafford-Smith M, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83(5 Suppl): S27-86.

18.

Despotis GJ, Filos KS, Zoys TN, Hogue CW Jr, Spitznagel E, Lappas DG. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients. Anesth Analg 1996; 82: 13-21.PubMed

19.

Levy JH, Dutton RP, Hemphill JC 3rd, Hemostasis Summit Participants, et al. Multidisciplinary approach to the challenge of hemostasis. Anesth Analg 2010; 110: 354-64.PubMedCrossRef

20.

Perry DJ, Fitzmaurice DA, Kitchen S, Mackie IJ, Mallett S. Point-of-care testing in haemostasis. Br J Haematol 2010; 150: 501-14.PubMedCrossRef

21.

LaValley MP. Logistic regression. Circulation 2008; 117: 2395-9.PubMedCrossRef

22.

Dillman DA. Reduction of coverage and sampling errors. Mail and Internet Surveys. The Tailored Design Method. John Wiley and Sons, New York, 2000: 194-216.

23.

Middelburg RA, van de Watering LM, van der Bom JG. Blood transfusions: good or bad? Confounding by indication, an underestimated problem in clinical transfusion research. Transfusion 2010; 50: 1181-3.PubMedCrossRef

24.

Karkouti K, McCluskey SA, Syed S, Pazaratz C, Poonawala H, Crowther MA. The influence of perioperative coagulation status on postoperative blood loss in complex cardiac surgery: a prospective observational study. Anesth Analg 2010; 110: 1533-40.PubMedCrossRef

Titel: The rationale for platelet transfusion during cardiopulmonary bypass: an observational study
verfasst von: Nusrat Zaffar
Ashley Joseph
C. David Mazer, MD
Rosane Nisenbaum, PhD
Keyvan Karkouti, MD
Alan Tinmouth, MD
Mark D. Peterson, MD
Katerina Pavenski, MD
Jeannie Callum, MD
Christine Cserti-Gazdewich, MD
Nadine Shehata, MD
Publikationsdatum: 01.04.2013
Verlag: Springer-Verlag
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 4/2013
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-012-9878-2

Neu im Fachgebiet AINS

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

The rationale for platelet transfusion during cardiopulmonary bypass: an observational study