| Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. | |
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MedLine Citation:
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PMID: 20951260 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements. METHODS: Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n = 27) with thromboelastometrically guided transfusion algorithm or control group (n = 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused. RESULTS: Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P = .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P = .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p = 0.5) and rate of surgical re-exploration (19% vs 24%, P = .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P = .03) in multivariable logistic regression analysis. CONCLUSIONS: Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest. |
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Authors:
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Evaldas Girdauskas; Jörg Kempfert; Thomas Kuntze; Michael A Borger; Jörg Enders; Jens Fassl; Volkmar Falk; Friedrich-Wilhelm Mohr |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-18 Completed Date: 2010-11-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1117-24.e2 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. evagird@centras.lt |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Algorithms Aorta / surgery* Blood Coagulation* Blood Loss, Surgical / prevention & control* Blood Transfusion* Circulatory Arrest, Deep Hypothermia Induced / adverse effects* Female Germany Humans Intraoperative Care Logistic Models Male Middle Aged Odds Ratio Postoperative Hemorrhage / blood, etiology, prevention & control* Prospective Studies Reoperation Risk Assessment Risk Factors Thrombelastography* Treatment Outcome Vascular Surgical Procedures / adverse effects* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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