Document Detail


Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes.
MedLine Citation:
PMID:  9299961     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
G J Despotis; J H Joist; L T Goodnough
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Clinical chemistry     Volume:  43     ISSN:  0009-9147     ISO Abbreviation:  Clin. Chem.     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-10-09     Completed Date:  1997-10-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421549     Medline TA:  Clin Chem     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1684-96     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA. despotig@notes.wustl.edu
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Anticoagulants / therapeutic use
Blood Coagulation Disorders / blood,  diagnosis
Blood Coagulation Factors / analysis
Blood Loss, Surgical*
Blood Platelets / physiology
Blood Transfusion*
Cardiac Surgical Procedures*
Cardiopulmonary Bypass
Fibrinolysis
Hemostasis*
Heparin / therapeutic use
Humans
Intraoperative Complications / epidemiology,  prevention & control
Monitoring, Intraoperative*
Risk Factors
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Blood Coagulation Factors; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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