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Ann Thorac Surg 1996;62:1907
© 1996 The Society of Thoracic Surgeons

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Supplement on Bleeding and Transfusion

Introduction

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

The "Groupe d'Intérêt en Hémostase Périopératoire" (GIHP; Perioperative Hemostasis Interest Group) was founded in 1994 when French-speaking physicians from Canada and Europe, sharing a common interest for hemostatic problems in the perioperative setting, felt the need to meet regularly and exchange information on this relatively limited area of medical practice. The GIHP is composed of anesthesiologists, hematologists, and surgeons involved in the care of patients at high risk of presenting disorders of hemostasis (whether hemorrhagic or thrombotic) during or after operations. Its mission is to provide a forum for discussion, to identify areas where more research is necessary, to conduct such research as is appropriate and feasible, and to promote solutions as they become available.

It is well known to all those involved in the care of cardiac surgical patients that the use of extracorporeal circulation may give rise to major hemostatic and inflammatory disturbances. Thus, it appeared natural and appropriate that the GIHP should consider these patients first because they are at a substantial risk of bleeding and of receiving allogeneic blood transfusions after cardiopulmonary bypass. Many prophylactic and therapeutic modalities have been put forward to control the disturbances associated with extracorporeal circulation, but the relative merits of the proposed therapies remain unclear. Part of the confusion stems, we believe, from the use of varying (and sometimes inappropriate) end points to evaluate the efficacy of these therapies. The objective of the articles that follow is to present to clinicians a global view of the present situation so that they may adopt the best possible strategies for the adult and pediatric patients under their care.

The articles are organized from a clinical perspective. The first article reviews the epidemiology of excessive postoperative drainage and the need for allogeneic blood products, and reexamines a few of the convictions that guide our practice. The next two articles deal with the preoperative clinical and laboratory evaluation of hemostasis, questioning the need for routine blood testing even in cardiopulmonary bypass patients. The following section deals with the hemocompatibility of extracorporeal circulation, reviews recent progress in the field, and discusses why we may never achieve total biocompatibility. Having set the scene, we reexamine the nonpharmacologic and the pharmacologic strategies currently available to clinicians to reduce or avoid transfusion of allogeneic blood because this is, after all, our main concern and objective. Despite all our efforts, some patients will bleed excessively after bypass and, consequently, the last adult section is devoted to the treatment of these patients. The final article reviews the problem of mediastinal bleeding after extracorporeal circulation in children and details the preoperative, intraoperative, and postoperative considerations specific to this population.

We hope you will find these reviews both interesting and useful in your everyday clinical practice. Unfortunately, we could not address all the issues so we chose to concentrate on those that had, in our minds at least, a major clinical impact. Hopefully, the important topics that were left out (the management and the monitoring of anticoagulation during bypass, for example) will be dealt with in the near future.

All authors devoted considerable time and energy to prepare their review of the literature. Because of the contingencies of contemporary editing, common to all major journals, only about 60 references could be included with each article. For the reader with a special interest in the field, each author concerned has agreed to provide, upon written request, a copy of his original, fully referenced manuscript to the interested reader.

In closing these introductory remarks, we wish to extend our warmest thanks to our colleagues from the Department of Anesthesia of the Montreal Heart Institute who gave us all the time and support required to prepare our own manuscripts and act as guest editors for the supplement as a whole.

Footnotes

Address reprint requests to Dr Hardy, Research Center, Montreal Heart Institute, 5000 Bélanger St E, Montreal, PQ H1T 1C8, Canada.

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