Perioperative Coagulation in Cardiovascular Surgery
The evolution of scientific knowledge in cardiac surgery and cardiopulmonary bypass has enabled the reduction of perioperative complications, despite an increase in patient-related risks and in the complexity of surgical procedures. However, the managemen
- PDF / 476,429 Bytes
- 24 Pages / 439.37 x 666.14 pts Page_size
- 100 Downloads / 199 Views
14
Fabrizio Gronchi and Marco Ranucci
14.1
Introduction
The evolution of scientific knowledge in cardiac surgery and cardiopulmonary bypass (CPB) has enabled the reduction of perioperative complications, despite an increase in patient-related risks and in the complexity of surgical procedures. However, the management of hemostasis and coagulation remains a difficult issue, and it is of note that the rates of allogeneic blood transfusion and surgical revision in bleeding patients have not declined in recent years. It is widely recognized that allogeneic blood transfusion carries risks of increased morbidity and mortality (Koch et al. 2006) and that there is a wide difference in transfusion thresholds and practice among hospitals. Transfusion is a controversial issue in cardiac surgery, and there are still gaps in knowledge with respect to indications, efficacy, and even safety. It is currently recognized that a restrictive transfusion policy, guided by point-ofcare (POC) tests, significantly reduces the number of transfused packed red blood cell (RBC) and fresh frozen plasma (FFP) units. Restrictive transfusion strategies do not alter perioperative morbidity (Hajjar et al. 2010) or postoperative quality of life. A number of risk factors help identify patients at high risk of receiving transfusions, including: • Chronic renal failure (CRF) • Chronic heart failure (CHF)
F. Gronchi (*) Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne CH-1011, Switzerland e-mail: [email protected] M. Ranucci Department of Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy e-mail: [email protected] C.E. Marcucci, P. Schoettker (eds.), Perioperative Hemostasis, DOI 10.1007/978-3-642-55004-1_14, © Springer-Verlag Berlin Heidelberg 2015
243
244
F. Gronchi and M. Ranucci
• • • •
Chronic obstructive pulmonary disease (COPD) in elderly patients Perioperative anticoagulation or antiaggregation Reduced RBC volume (preoperative anemia and/or small body surface) Complex surgery (emergency surgery, reoperation, aortic surgery, surgery other than coronary artery bypass grafting (CABG), long-lasting CPB) Different models for predicting the transfusion risk have been proposed and validated in cardiac surgery (Magovern et al. 1996; Litmathe et al. 2003; Karkouti et al. 2006; Alghamdi et al. 2006; Ranucci et al. 2009b). The guidelines in this chapter are supported by the recommendations of the Society of Thoracic Surgeons (STS) and the Society of Cardiovascular Anesthesiologists (SCA) clinical practice guidelines on blood conservation (Society of Thoracic Surgeons Blood Conservation Guideline Task Force et al. 2011). Additional information is provided by clinical practice, expert opinions, and other guidelines and recommendations.
14.2
Preoperative Treatment with Anticoagulants and/or Antiaggregant Agents
Due to the nature of their disease, cardiac surgery patients are usually treated with anticoagulants and/or antiaggregant agents. The optim
Data Loading...
