ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bélisle, S.
Right arrow Articles by Hardy, J.-F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bélisle, S.
Right arrow Articles by Hardy, J.-F.

Ann Thorac Surg 1996;62:1908-1917
© 1996 The Society of Thoracic Surgeons

Supplement on Bleeding and Transfusion

Hemorrhage and the Use of Blood Products After Adult Cardiac Operations: Myths and Realities

Sylvain Bélisle, MD, Jean-François Hardy, MD

Department of Anesthesia, Montreal Heart Institute, and University of Montreal, Montreal, Quebec, Canada

Abstract

Background. Several patient-, procedure-, and prescriber-related factors are thought to influence the decision to administer allogeneic blood products. We reexamine a number of assertions applied commonly to the practice of transfusion in cardiac operations.

Methods. More than 50 original articles including a total of more than 10,000 patients from 70 centers were reviewed. Data from 5,426 patients operated on between 1990 and 1994 at the Montreal Heart Institute are presented.

Results. From our review of the literature, we conclude that postoperative mediastinal fluid drainage averages 917 mL and that aspirin therapy increases drainage by less than 300 mL in most studies, which should not increase use of blood products, insofar as a strict transfusional protocol is adhered to. Across centers, transfusions can vary eightfold for the same postoperative drainage. Data from our institution show that postoperative mediastinal drainage per se is not influenced by reoperation or by the type of operation. However, total blood losses and transfusion requirements remain increased in reoperative and complex procedures. Excessive mediastinal drainage resulting in increased transfusions occurs in 29% of patients.

Conclusions. Exposure to allogeneic transfusions remains institution dependent. Constant reevaluation of local practice is essential to implement efficient blood conservation strategies.




This article has been cited by other articles:


Home page
 Eur J Cardiothorac SurgHome page
A. J. Chapman, A. L. Blount, A. T. Davis, and R. L. Hooker
Recombinant factor VIIa (NovoSeven RT) use in high risk cardiac surgery
Eur J Cardiothorac Surg, December 1, 2011; 40(6): 1314 - 1319.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
M. Hacquard, M. Durand, T. Lecompte, S. Boini, S. Briancon, and J.-P. Carteaux
Off-label use of recombinant activated factor VII in intractable haemorrhage after cardiovascular surgery: an observational study of practices in 23 French cardiac centres (2005-7)
Eur J Cardiothorac Surg, December 1, 2011; 40(6): 1320 - 1327.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
A. Vuylsteke, C. Pagel, C. Gerrard, B. Reddy, S. Nashef, P. Aldam, and M. Utley
The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding
Eur J Cardiothorac Surg, June 1, 2011; 39(6): 924 - 930.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
P. S. Myles
Stopping Aspirin Before Coronary Artery Surgery: Between the Devil and the Deep Blue Sea
Circulation, February 15, 2011; 123(6): 571 - 573.
[Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
T.-H. Chen and R. Matyal
The Management of Antiplatelet Therapy in Patients With Coronary Stents Undergoing Noncardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2010; 14(4): 256 - 273.
[Abstract] [PDF]

Home page
 ASH Education BookHome page
A. C. Logan and L. T. Goodnough
Recombinant Factor VIIa: An Assessment of Evidence Regarding Its Efficacy and Safety in the Off-Label Setting
Hematology, December 1, 2010; 2010(1): 153 - 159.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
H. Mollmann, H. M. Nef, and C. W. Hamm
Antiplatelet therapy during surgery
Heart, June 1, 2010; 96(12): 986 - 991.
[Full Text] [PDF]

Home page
 Interact CardioVasc Thorac SurgHome page
S. M. Reddy, S. Talwar, D. Velayoudam, P. Gharde, V. Mallick, R. K. Jha, L. Kumar, and S. K. Arkalgud
Multi-modality blood conservation strategy in open-heart surgery: an audit
Interact CardioVasc Thorac Surg, September 1, 2009; 9(3): 480 - 482.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
J. M. O'Riordan, R. J. Margey, G. Blake, and P. R. O'Connell
Antiplatelet Agents in the Perioperative Period
Arch Surg, January 1, 2009; 144(1): 69 - 76.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom
Transfusion Therapy and Blood Conservation
Card. Surg. Adult, January 1, 2008; 3(2008): 415 - 430.
[Full Text]

Home page
 Br J AnaesthHome page
P.-G. Chassot, A. Delabays, and D. R. Spahn
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al.
Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline
Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. Dial, E. Delabays, M. Albert, A. Gonzalez, J. Camarda, A. Law, and D. Menzies
Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass
J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 654 - 654.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. P. Cannon, S. R. Mehta, and S. F. Aranki
Balancing the Benefit and Risk of Oral Antiplatelet Agents in Coronary Artery Bypass Surgery
Ann. Thorac. Surg., August 1, 2005; 80(2): 768 - 779.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. K. Banbury, J. A. White, E. H. Blackstone, and D. M. Cosgrove III
Vacuum-assisted venous return reduces blood usage
J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 680 - 687.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
J. M. Karski and J. T. Balatbat
Blood Conservation Strategies in Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2003; 7(2): 175 - 188.
[Abstract] [PDF]

Home page
 ChestHome page
A. Sedrakyan, K. Gondek, D. Paltiel, and J. A. Elefteriades
Volume Expansion With Albumin Decreases Mortality After Coronary Artery Bypass Graft Surgery
Chest, June 1, 2003; 123(6): 1853 - 1857.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Durand and O. Chavanon
Does hydroxyethyl starch increase blood loss in cardiac operations
Ann. Thorac. Surg., May 1, 2003; 75(5): 1682 - 1683.
[Full Text] [PDF]

Home page
 Card Surg AdultHome page
L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom
Transfusion Therapy and Blood Conservation
Card. Surg. Adult, January 1, 2003; 2(2003): 389 - 400.
[Full Text]

Home page
 Ann. Thorac. Surg.Home page
B. Collier, J. Kolff, R. Devineni, and L. S. Gonzalez III
Prophylactic positive end-expiratory pressure and reduction of postoperative blood loss in open-heart surgery
Ann. Thorac. Surg., October 1, 2002; 74(4): 1191 - 1194.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Johnell, G. Elgue, R. Larsson, A. Larsson, S. Thelin, and A. Siegbahn
Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface
J. Thorac. Cardiovasc. Surg., August 1, 2002; 124(2): 321 - 332.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. M. Wilkes
Reply
Ann. Thorac. Surg., May 1, 2002; 75(5): 1683 - 1683.
[Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
P. R. Belcher and E. W. Muriithi
Coronary artery bypass grafting surgery without the routine application of blood products: is it feasible?
Eur J Cardiothorac Surg, November 1, 2001; 20(5): 1078 - 1078.
[Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
K. Kottke-Marchant and S. Sapatnekar
Hemostatic Abnormalities in Cardiopulmonary Bypass: Pathophysiologic and Transfusion Considerations
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 187 - 206.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. M. Wilkes, R. J. Navickis, and W. J. Sibbald
Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding
Ann. Thorac. Surg., August 1, 2001; 72(2): 527 - 533.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
C. M. Lehman, R. C. Blaylock, D. P. Alexander, and G. M. Rodgers
Discontinuation of the Bleeding Time Test without Detectable Adverse Clinical Impact
Clin. Chem., July 1, 2001; 47(7): 1204 - 1211.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. W. Muriithi, P. R. Belcher, S. P. Day, V. C. Menys, and D. J. Wheatley
Heparin-induced platelet dysfunction and cardiopulmonary bypass
Ann. Thorac. Surg., June 1, 2000; 69(6): 1827 - 1832.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
G. D. Williams, S. L. Bratton, and C. Ramamoorthy
Factors Associated with Blood Loss and Blood Product Transfusions: A Multivariate Analysis in Children After Open-Heart Surgery
Anesth. Analg., July 1, 1999; 89(1): 57 - 57.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
M. J. R. Dalrymple-Hay, L. Pack, C. D. Deakin, S. Shephard, S. K. Ohri, M. P. Haw, S. A. Livesey, and J. L. Monro
Autotransfusion of washed shed mediastinal fluid decreases the requirement for autologous blood transfusion following cardiac surgery: a prospective randomized trial
Eur J Cardiothorac Surg, June 1, 1999; 15(6): 830 - 834.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. D. Williams, S. L. Bratton, E. C. Riley, and C. Ramamoorthy
Association between age and blood loss in children undergoing open heart operations
Ann. Thorac. Surg., September 1, 1998; 66(3): 870 - 875.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. S. Gammie, M. Zenati, R. L. Kormos, B. G. Hattler, L. M. Wei, R. V. Pellegrini, B. P. Griffith, and C. M. Dyke
Abciximab and Excessive Bleeding in Patients Undergoing Emergency Cardiac Operations
Ann. Thorac. Surg., February 1, 1998; 65(2): 465 - 469.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. K. Rosengart, W. DeBois, M. O'Hara, R. Helm, M. Gomez, S. J. Lang, N. Altorki, W. Ko, G. S. Hartman, O. W. Isom, et al.
Retrograde Autologous Priming For Cardiopulmonary Bypass: A Safe And Effective Means Of Decreasing Hemodilution And Transfusion Requirements
J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 426 - 439.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1996 by The Society of Thoracic Surgeons.