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Oak Ridge Conference |
Departments of Anesthesiology, Internal Medicine, and Pathology, Washington University School of Medicine, St. Louis, MO 63110.
1
Departments of Pathology and Internal Medicine, St.
Louis University School of Medicine, St. Louis, MO 63110.
a Author for correspondence: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Box 8054, Washington University School of Medicine, 660 South Euclid Ave., St. Louis, MO 63110.
Abstract
Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. Strategies to optimize administration of heparin and protamine and the assessment of their effects on coagulation are evolving in cardiac surgical patients. Two recent evaluations have focused on the use of multiple point-of-care (POC) coagulation assays for patient-specific adjustment of heparin and protamine dosage. These studies indicate that blood loss and transfusion requirements in cardiac surgical patients may be reduced with more accurate control of heparin anticoagulation and its reversal. Blood component administration in patients with excessive post-CPB bleeding is generally empiric in part, related to turnaround times of laboratory-based tests. Methods are now available for rapid, POC assessment of coagulation to allow appropriate, targeted therapy for acquired hemostatic abnormalities. Recent studies indicate that a rapid evaluation of thrombocytopenia and coagulation factor deficiencies with POC tests can facilitate the optimal administration of pharmacologic and transfusion-based therapy in patients who exhibit excessive bleeding after CPB. POC tests that assess platelet function have been developed, and their use may facilitate identification of which patients at risk for excessive blood loss may respond to pharmacologic interventions such as desmopressin acetate or antifibrinolytic agents.
The following articles in journals at HighWire Press have cited this article:
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  The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, 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., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
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 A. Chung, S. M. Wildhirt, S. Wang, A. Koshal, and M. W. Radomski Combined administration of nitric oxide gas and iloprost during cardiopulmonary bypass reduces platelet dysfunction: A pilot clinical study J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 782 - 790. [Abstract] [Full Text] [PDF]
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 M. S. Avidan, E. L. Alcock, J. Da Fonseca, J. Ponte, J. B. Desai, G. J. Despotis, and B. J. Hunt 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., February 1, 2004; 92(2): 178 - 186. [Abstract] [Full Text] [PDF]
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 S. L Gutierres and T. E Welty Point-of-Care Testing: An Introduction Ann. Pharmacother., January 1, 2004; 38(1): 119 - 125. [Abstract] [Full Text] [PDF]
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 P D Raymond, M J Ray, S N Callen, and N A Marsh Heparin monitoring during cardiac surgery. Part 1: validation of whole-blood heparin concentration and activated clotting time Perfusion, September 1, 2003; 18(5): 269 - 276. [Abstract] [PDF]
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 T. W. Stief and J. Fareed Point of Care: Diagnostics in Hemostasisthe Wrong Direction? Clinical and Applied Thrombosis/Hemostasis, July 1, 2003; 9(3): 191 - 195. [Abstract] [PDF]
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D. J. Goldstein and R. B. Beauford Left ventricular assist devices and bleeding: adding insult to injury Ann. Thorac. Surg., June 1, 2003; 75(90060): S42 - 47. [Abstract] [Full Text] [PDF]
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 A. M.-H. Ho, A. Lee, E. Ling, A. Daly, K. Teoh, and T. E. Warkentin Agreements Between the Prothrombin Times of Blood Treated In Vitro with Heparinase During Cardiopulmonary Bypass (CPB) and Blood Sampled After CPB and Systemic Protamine Anesth. Analg., January 1, 2003; 96(1): 15 - 20. [Abstract] [Full Text] [PDF]
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 L. Shore-Lesserson Monitoring the Hematologic Complications of Cardiopulmonary Bypass Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 207 - 216. [Abstract] [PDF]
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N. J. Skubas and G. J. Despotis Optimal Management of Bleeding Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 217 - 228. [Abstract] [PDF]
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S. D. Mentzelopoulos, J. N. Kokotsakis, C. N. Romana, and E. A. Karamichali Intracoronary Thrombolysis and Intraaortic Balloon Counterpulsation for the Emergency Treatment of Probable Coronary Embolism After Repair of an Acute Ascending Aortic Dissection Anesth. Analg., July 1, 2001; 93(1): 56 - 59. [Abstract] [Full Text] [PDF]
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 C. P Price Regular review: Point of care testing BMJ, May 26, 2001; 322(7297): 1285 - 1288. [Full Text] [PDF]
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R. Ascione, S. Williams, C. T. Lloyd, T. Sundaramoorthi, A. A. Pitsis, and G. D. Angelini Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: A prospective randomized study J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 689 - 696. [Abstract] [Full Text] [PDF]
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M. Wallock, W. P Jeske, M. Bakhos, and J. M Walenga Evaluation of a new point of care heparin test for cardiopulmonary bypass: the TAS heparin management test Perfusion, March 1, 2001; 16(2): 147 - 153. [Abstract] [PDF]
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G. J. Despotis and L. T. Goodnough Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32. [Abstract] [Full Text] [PDF]
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 P. M. Rainey Outcomes Assessment for Point-of-Care Testing Clin. Chem., August 1, 1998; 44(8): 1595 - 1596. [Full Text] [PDF]
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N. Ramamurthy, N. Baliga, J. A. Wahr, U. Schaller, V. C. Yang, and M. E. Meyerhoff Improved protamine-sensitive membrane electrode for monitoring heparin concentrations in whole blood via protamine titration§ Clin. Chem., March 1, 1998; 44(3): 606 - 613. [Abstract] [Full Text] [PDF]
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