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Cited by 303Blood transfusion and managementTrauma, Hemostasis, Coagulopathy, ResuscitationCardiac and Coronary Surgery Techniques

Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery

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Avidan, M.S., Alcock, E.L., Da Fonseca, J, Ponte, J, Desai, J.B., Despotis, G.J., Hunt, B.J.·2004·British Journal of Anaesthesia
DOI 10.1093/bja/aeh037
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Abstract

Background Using algorithms based on point of care coagulation tests can decrease blood loss and blood component transfusion after cardiac surgery. We wished to test the hypothesis that a management algorithm based on near-patient tests would reduce blood loss and blood component use after routine coronary artery surgery with cardiopulmonary bypass when compared with an algorithm based on routine laboratory assays or with clinical judgement. Methods Patients (n=102) undergoing elective coronary artery surgery with cardiac bypass were randomized into two groups. In the point of care group, the management algorithm was based on information provided by three devices, the Hepcon, thromboelastography and the PFA-100 platelet function analyser. Management in the laboratory test group depended on rapidly available laboratory clotting tests and transfusion of haemostatic blood components only if specific criteria were met. Blood loss and transfusion was compared between these two groups and with a retrospective case-control group (n=108), in which management of bleeding had been according to the clinician's discretion. Results All three groups had similar median blood losses. The transfusion of packed red blood cells (PRBCs) and blood components was greater in the clinician discretion group (P<0.05) but there was no difference in the transfusion of PRBCs and blood components between the two algorithm-guided groups. Conclusion Following algorithms based on point of care tests or on structured clinical practice with standard laboratory tests does not decrease blood loss, but reduces the transfusion of PRBCs and blood components after routine cardiac surgery, when compared with clinician discretion. Cardiac surgery services should use transfusion guidelines based on laboratory-guided algorithms, and the possible benefits of point of care testing should be tested against this standard.

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  • Algorithm-based hemostatic therapy is superior to empiric hemostatic therapy based on clinical judgment.

    “In this context, algorithm-based hemostatic therapy has been shown to be superior to empiric hemostatic therapy that is based on clinical judgment.5”

    From Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients (2012) · cites this paper as [5]

    The Abstract and Discussion report that algorithm-guided management after routine cardiac surgery reduced transfusions compared with clinician discretion. They also report similar blood loss across groups, so the unqualified claim of superior hemostatic therapy is broader than the demonstrated benefit. (LLM, conf=0.84)

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Research works printed but not linked: 34

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Authors
Avidan, M. S., Alcock, E. L., Da Fonseca, J., Ponte, J., Desai, J. B., Despotis, G. J., & Hunt, B. J.
Affiliations
  • Washington University in St. Louis (US)
  • King's College Hospital (GB)
Corresponding author
Avidan, M.S.
ORCID
Venue
British Journal of Anaesthesia
Publisher
Elsevier BV
Published
2004-02
Volume
92
Issue
2
Pages
178-186
ISSN
0007-0912 (ISSN-L)
DOI
10.1093/bja/aeh037
OpenAlex
W2106213640
Cited by
303
References
1
Citations by year
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FWCI
9.46
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Anaesthesia (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • King's College London
  • Royal College of Anaesthetists
Topics
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords
postoperative bleeding, cardiac surgery, point-of-care coagulation testing, thromboelastography, blood loss, blood component transfusion, packed red blood cell transfusion, coronary artery bypass grafting, transfusion algorithm, clinical judgment
MeSH terms
Aged, Algorithms, Blood Transfusion, Cardiopulmonary Bypass, Clinical Competence, Diagnostic Tests, Routine, Female, Hemostasis, Surgical, Humans, Judgment, Male, Middle Aged, Platelet Function Tests, Retrospective Studies, Thrombelastography, Case-Control Studies, Point-of-Care Systems, Postoperative Hemorrhage

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