https://doi.org/10.4081/ahr.2024.5

The significant role of point-of-care coagulation studies: shorter cardiac surgery, better renal function and tranexamic acid cannot alone reduce early platelet transfusions

Vol. 1 No. 1 (2024)
Published: June 6, 2024
cardiopulmonary bypass, transfusions, platelets, tranexamic acid, thromboelastogram, fibrinogen, patient blood management
Abstract Views: 875
PDF: 66
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Kimberly L. Skidmore
https://orcid.org/0009-0007-0241-9971
Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport; Volunteer Associate Clinical Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, United States.
Grant Borne
https://orcid.org/0009-0005-1743-5937
School of Medicine, Louisiana State University Health Sciences Center at Shreveport, LA, United States.
Anusha Kallurkar
Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, LA, United States.
Denisa Pavlickova
https://orcid.org/0009-0001-4340-422X
Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, LA, United States.
Dariusz Myrcik
Department of Emergency Medicine, Faculty of Public Health, Medical University of Silesia, Bytom, Poland.
Giustino Varrassi
https://orcid.org/0000-0002-3822-2923
Paolo Procacci Foundation, Rome, Italy.
Sahar Shekoohi
Sahar.Shekoohi@lsuhs.edu
https://orcid.org/0009-0007-4545-4523
Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, LA, United States.
Alan D. Kaye
Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, LA, United States.

After cardiopulmonary bypass (CPB) approximately 20% of patients require platelets. In our safety-net hospital, the incidence of platelet transfusion is over 40%, perhaps attributable to our prevalent risk factors of renal dysfunction, CPB duration, and absence of tranexamic acid (TXA). We designed this retrospective observational study after surgeons decided against offering CPB in the presence of these risk factors. The Institutional Review Board (IRB) approved the protocol and waived informed consent. Our hypothesis was the number of platelet transfusions in the consecutive patients during the first ninety days of 2022 would be higher than those in 2023. Confounders included platelet counts and hemoglobin immediately before platelet transfusion. Secondary outcomes were postoperative day two creatinine and other components transfused. Preoperatively creatinine trended higher in 2022 at 1.5 vs 1.1, reaching significance postoperatively at 1.9 vs 1.1 (p=0.02). CPB decreased from 174 to 124 min (p=0.06). TXA use increased from 18 of 28 to 26 of 29 patients. Platelets during CPB increased (142 to 173, p=0.06). Hemoglobin nadirs rose (8 g/dL to 8.8, p=0.04). Platelet units transfused per patient tended to rise (0.7±1 vs 0.93±1.5); if exposed, patients tended to receive more units (2.1±1.3 vs 2.5±1.4) sooner. These data support a need for thromboelastograms with platelet mapping immediately post-CPB.

Dimensions

Altmetric

PlumX Metrics

Downloads

Citations

How to Cite

The significant role of point-of-care coagulation studies: shorter cardiac surgery, better renal function and tranexamic acid cannot alone reduce early platelet transfusions. (2024). Advancements in Health Research, 1(1). https://doi.org/10.4081/ahr.2024.5
Chegini A. Evaluating the importance of patient blood management during COVID-19 pandemic. Anesth Pain Med 2022;11:e112910. DOI: https://doi.org/10.5812/aapm.112910
Fleming K, Redfern RE, March RL, et al. TEG-directed transfusion in complex cardiac surgery: Impact on blood product usage. J Extra Corpor Technol 2017;49:283-290. DOI: https://doi.org/10.1051/ject/201749283
Zaffar N, Joseph A, Mazer CD, et al. The rationale for platelet transfusion during cardiopulmonary bypass: an observational study. Can J Anaesth 2013;60:345-54. DOI: https://doi.org/10.1007/s12630-012-9878-2
Hasan O, Tung RC, Freeman H, et al. Thromboelastography after cardiopulmonary bypass: Does it save blood products? Kans J Med 2022;15:27-30. DOI: https://doi.org/10.17161/kjm.vol15.15789
Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res 2016;203:424-33. DOI: https://doi.org/10.1016/j.jss.2016.03.008
Karkouti K, Callum J, Wijeysundera DN, et al. Point-of-care hemostatic testing in cardiac surgery: A stepped-wedge clustered randomized controlled trial. Circulation 2016;134:1152-62. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.023956
Erdoes G, Faraoni D, Koster A, et al. Perioperative considerations in management of the severely bleeding coagulopathic patient. Anesthesiology 2023;138:535-60. DOI: https://doi.org/10.1097/ALN.0000000000004520
Skidmore KL, Rajabi A, Nguyen, et al. Veno-venous extracorporeal membrane oxygenation: Anesthetic considerations in clinical practice. Anesthesiol Pain Med 2023;13:e136524. DOI: https://doi.org/10.5812/aapm-136524
Shi J, Zhou C, Pan W, et al. Effect of high- vs low-dose tranexamic acid infusion on need for red blood cell transfusion and adverse events in patients undergoing cardiac surgery: The OPTIMAL randomized clinical trial. JAMA 2022;328:336-47. DOI: https://doi.org/10.1001/jama.2022.10725
Saillant NN, Kornblith LZ, Moore H, et al. The national blood shortage-An impetus for change. Ann Surg 2022;275:641-3. DOI: https://doi.org/10.1097/SLA.0000000000005393
American College of Surgeons. Massive transfusion in trauma. Accessed: September 27, 2023. Available from https://www.facs.org/media/zcjdtrd1/transfusion_guildelines.pdf
Fletcher CM, Hinton JV, Xing Z, et al. Platelet transfusion after cardiac surgery. J Cardiothorac Vasc Anesth 2023;37:528-38. DOI: https://doi.org/10.1053/j.jvca.2022.12.009
Hinton JV, Xing Z, Fletcher CM, et al. Cryoprecipitate transfusion after cardiac surgery. Heart Lung Circ 2023;32:414-23. DOI: https://doi.org/10.1016/j.hlc.2022.11.007
Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA), Boer C, Meesters MI, et al. 2017 EACTS/ EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth 2018;32:88-120.
U.S. Food and Drug Administration. Riastap. Accessed: September 27, 2023. Available from: https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/riastap
Lin PS, Yao YT, Tian LJ, et al. The efficacy and safety of intravenous administration of tranexamic acid in patients undergoing cardiac surgery: Evidence from a single cardiovascular center. Medicine (Baltimore) 2023;19;102:e33819. DOI: https://doi.org/10.1097/MD.0000000000033819
Guo J, Gao X, Ma Y, et al. Different dose regimens and administration methods of tranexamic acid in cardiac surgery: a meta-analysis of randomized trials. BMC Anesthesiol 2019;19:129. DOI: https://doi.org/10.1186/s12871-019-0772-0
Hodgson S, Larvin JT, Dearman C. What dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery? Interact Cardiovasc Thorac Surg 2015;21:384-8. DOI: https://doi.org/10.1093/icvts/ivv134
Couture P, Lebon JS, Laliberte E, et al. Low-dose versus high-dose tranexamic acid reduces the risk of nonischemic seizures after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2017;31:1611-7. DOI: https://doi.org/10.1053/j.jvca.2017.04.026
Kuhn V, Diederich L, Keller TCS 4th, et al. Red blood cell function and dysfunction: Redox regulation, nitric oxide metabolism, anemia. Antioxid Redox Signal 2017;26:718-42. DOI: https://doi.org/10.1089/ars.2016.6954
Jeong SK, Cho YI, Duey M, et al. Cardiovascular risks of anemia correction with erythrocyte stimulating agents: should blood viscosity be monitored for risk assessment? Cardiovasc Drugs Ther 2010;24:151-60. DOI: https://doi.org/10.1007/s10557-010-6239-7
Beris AN, Horner JS, Jariwala S, et al. Recent advances in blood rheology: a review. Soft Matter 2021;17:10591-613. DOI: https://doi.org/10.1039/D1SM01212F
Varchanis S, Dimakopoulos Y, Wagner C, et al. How viscoelastic is human blood plasma? Soft Matter 2018;14:4238-51. DOI: https://doi.org/10.1039/C8SM00061A
Tirotta CF, Lagueruela RG, Salyakina D, et al. Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients. J Cardiothorac Surg 2019;14:139. DOI: https://doi.org/10.1186/s13019-019-0949-0
Bhardwaj V, Malhotra P, Hasija S, et al. Coagulopathies in cyanotic cardiac patients: An analysis with three point of care testing devices. Ann Card Anaesth 2017;20:212-8. DOI: https://doi.org/10.4103/aca.ACA_4_17
Gorlinger K, Dirkmann D, Hanke AA. Potential values of transfusion protocols in cardiac surgery. Curr Opin Anaesthesiol 2013;26:230-43. DOI: https://doi.org/10.1097/ACO.0b013e32835ddca6
Naguib AN, Carrillo SA, Corridore M, et al. A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery. J Extra Corpor Technol 2023;55:60-9. DOI: https://doi.org/10.1051/ject/2023017
Agarwal S, Abdelmotieleb M. Viscoelastic testing in cardiac surgery. Transfusion 2020;60:S52-S60. DOI: https://doi.org/10.1111/trf.16075
Demailly Z, Wurtz V, Barbay V, et al. Point-of-care viscoelastic hemostatic assays in cardiac surgery patients: Comparison of thromboelastography 6S, Thromboelastometry Sigma, and Quantra. J Cardiothorac Vasc Anesth 2023;37:948-55. DOI: https://doi.org/10.1053/j.jvca.2023.02.015
Whiting P, Al M, Westwood M, et al. Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of hemostasis: a systematic review and cost-effectiveness analysis. Health Technol Assess 2015;19:1-228. DOI: https://doi.org/10.3310/hta19580
Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015;313:471-82. DOI: https://doi.org/10.1001/jama.2015.12

How to Cite

The significant role of point-of-care coagulation studies: shorter cardiac surgery, better renal function and tranexamic acid cannot alone reduce early platelet transfusions. (2024). Advancements in Health Research, 1(1). https://doi.org/10.4081/ahr.2024.5
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.