Coronary artery bypass surgery perioperative bleeding/transfusion
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Coronary Artery Bypass Surgery Microchapters | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]
ACCF/AHA Guidelines for Perioperative Bleeding/Transfusion[1]
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Class I1. Lysine analogues are useful intraoperatively and postoperatively in patients undergoing on-pump CABG to reduce perioperative blood loss and transfusion requirements.[2][3][4][5][6][7][8][9] (Level of Evidence: A) 2. A multimodal approach with transfusion algorithms, point-of-care testing, and a focused blood conservation strategy should be used to limit the number of transfusions.[10][11][12][13][14][15] (Level of Evidence: A) 3. In patients taking thienopyridines (clopidogrel or prasugrel) or ticagrelor in whom elective CABG is planned, clopidogrel and ticagrelor should be withheld for at least 5 days520,521,523,524,531,1058–1063 (Level of Evidence: B) and prasugrel for at least 7 days533 (Level of Evidence: C) before surgery. 4. It is recommended that surgery be delayed after the administration of streptokinase, urokinase, and tissue-type plasminogen activators until hemostatic capacity is restored, if possible. The timing of recommended delay should be guided by the pharmacodynamic half-life of the involved agent. (Level of Evidence: C) 5. Tirofiban or eptifibatide should be discontinued at least 2 to 4 hours before CABG and abciximab at least 12 hours before CABG.526–528,1049,1050,1064–1068 (Level of Evidence: B) Class IIa1. It is reasonable to consider off-pump CABG to reduce perioperative bleeding and allogeneic blood transfusion.67,1069–1074 (Level of Evidence: A) |
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Guidelines Resources
- 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1]
References
- ↑ 1.0 1.1 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
- ↑ Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R (2008). "A comparison of aprotinin and lysine analogues in high-risk cardiac surgery". The New England Journal of Medicine. 358 (22): 2319–31. doi:10.1056/NEJMoa0802395. PMID 18480196. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall GA, Beckham JM, Wall MH, Butterworth JF (2009). "The effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypass surgery: a randomized, double-blind, placebo-controlled, noninferiority trial". Anesthesia and Analgesia. 109 (1): 15–24. doi:10.1213/ane.0b013e3181a40b5d. PMID 19535691. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Kikura M, Levy JH, Tanaka KA, Ramsay JG (2006). "A double-blind, placebo-controlled trial of epsilon-aminocaproic acid for reducing blood loss in coronary artery bypass grafting surgery". Journal of the American College of Surgeons. 202 (2): 216–22, quiz A44–5. doi:10.1016/j.jamcollsurg.2005.10.001. PMID 16427545. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Mehr-Aein A, Sadeghi M, Madani-civi M (2007). "Does tranexamic acid reduce blood loss in off-pump coronary artery bypass?". Asian Cardiovascular & Thoracic Annals. 15 (4): 285–9. PMID 17664199. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Mehr-Aein A, Davoodi S, Madani-Civi M (2007). "Effects of tranexamic acid and autotransfusion in coronary artery bypass". Asian Cardiovascular & Thoracic Annals. 15 (1): 49–53. PMID 17244923. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Murphy GJ, Mango E, Lucchetti V, Battaglia F, Catapano D, Rogers CA, Angelini GD (2006). "A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 132 (3): 475–80, 480.e1–8. doi:10.1016/j.jtcvs.2006.01.064. PMID 16935098. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Santos AT, Kalil RA, Bauemann C, Pereira JB, Nesralla IA (2006). "A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting". [[Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas / Sociedade Brasileira De Biofísica ... [Et Al.]]]. 39 (1): 63–9. doi:/S0100-879X2006000100007 Check
|doi=value (help). PMID 16400465. Retrieved 2011-12-19. Unknown parameter|month=ignored (help) - ↑ Taghaddomi RJ, Mirzaee A, Attar AS, Shirdel A (2009). "Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery". Journal of Cardiothoracic and Vascular Anesthesia. 23 (3): 312–5. doi:10.1053/j.jvca.2008.09.018. PMID 19103500. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Paone G, Spencer T, Silverman NA (1994). "Blood conservation in coronary artery surgery". Surgery. 116 (4): 672–7, discussion 677–8. PMID 7940165. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, Ereth MH (2001). "Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass". Anesthesiology. 94 (5): 773–81, discussion 5A–6A. PMID 11388527. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Royston D, von Kier S (2001). "Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass". British Journal of Anaesthesia. 86 (4): 575–8. PMID 11573637. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Avidan MS, Alcock EL, Da Fonseca J, Ponte J, Desai JB, Despotis GJ, Hunt BJ (2004). "Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery". British Journal of Anaesthesia. 92 (2): 178–86. PMID 14722166. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ Despotis GJ, Grishaber JE, Goodnough LT (1994). "The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery". Transfusion. 34 (4): 290–6. PMID 8178325. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA (1999). "Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery". Anesthesia and Analgesia. 88 (2): 312–9. PMID 9972747. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help)