Cited by 626Blood transfusion and managementTrauma, Hemostasis, Coagulopathy, ResuscitationCardiac and Coronary Surgery Techniques

The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index; 13 of the 47 sources its claims cite were checked for support.

Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients

Open access

Abstract

Introduction: The current investigation aimed to study the efficacy of hemostatic therapy guided either by conventional coagulation analyses or point-of-care (POC) testing in coagulopathic cardiac surgery patients. Methods: Patients undergoing complex cardiac surgery were assessed for eligibility. Those patients in whom diffuse bleeding was diagnosed after heparin reversal or increased blood loss during the first 24 postoperative hours were enrolled and randomized to the conventional or POC group. Thromboelastometry and whole blood impedance aggregometry have been performed in the POC group. The primary outcome variable was the number of transfused units of packed erythrocytes during the first 24 h after inclusion. Secondary outcome variables included postoperative blood loss, use and costs of hemostatic therapy, and clinical outcome parameters. Sample size analysis revealed a sample size of at least 100 patients per group. Results: There were 152 patients who were screened for eligibility and 100 patients were enrolled in the study. After randomization of 50 patients to each group, a planned interim analysis revealed a significant difference in erythrocyte transfusion rate in the conventional compared with the POC group [5 (4;9) versus 3 (2;6) units [median (25 and 75 percentile)], P<0.001]. The study was terminated early. The secondary outcome parameters of fresh frozen plasma and platelet transfusion rates, postoperative mechanical ventilation time, length of intensive care unit stay, composite adverse events rate, costs of hemostatic therapy, and 6-month mortality were lower in the POC group. Conclusions: Hemostatic therapy based on POC testing reduced patient exposure to allogenic blood products and provided significant benefits with respect to clinical outcomes.

Overview

Integrity signals

Registry

Crossref · 10.1097/aln.0b013e318264c644

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

34 Own result · 24 Own method · 10 Own interpretation · 7 Partly supported · 6 Sources not found · 3 No full text of the sources · 3 Not checked yet · 2 Supported so far · 1 Supported · 1 Couldn’t confirm · accuracy not yet measured

Show all 58 claims

  • It may state two separate claims as one. 24
  • Probably not a substantial claim. 12
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  • The paper relies on this without support.

    The clinical criteria used for enrollment (diffuse bleeding from capillary beds or blood loss exceeding 250 ml/h or 50 ml/10 min) identify patients with coagulopathy requiring hemostatic therapy.

    “Patients were enrolled in the study after heparin reversal following CPB if at least one of the two inclusion criteria were fulfilled: (1) diffuse bleeding from capillary beds at wound surfaces requiring hemostatic therapy as assessed by the anesthesiologist and surgeon by inspecting the operative field and/or (2) intraoperative or postoperative (during the first 24 postoperative hours) blood loss”
  • The paper relies on this without support.

    The amount of transfused packed erythrocytes is a reliable surrogate parameter for the efficacy of hemostatic therapy.

    “Because the amount of transfused packed erythrocytes represents a reliable surrogate parameter for the efficacy of hemostatic therapy, it was defined as the primary outcome variable of the current study.”
  • The paper relies on this without support.

    Bleeding and the consecutive need for transfusion of packed erythrocytes in the intraoperative period and the first 24 h after surgery reflect the surgery-associated coagulopathy and the potential effects of different hemostatic strategies.

    “Bleeding and the consecutive need for transfusion of packed erythrocytes in the intraoperative period and the first 24 h after surgery most likely reflect the surgery-associated coagulopathy and thus the potential effects of different hemostatic strategies.”
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Citations

Cites

Research works printed but not linked: 8

  1. [4]4. Levy JH, Dutton RP, Hemphill JC 3rd, Shander A, Cooper D, Paidas MJ, Kessler CM, Holcomb JB, Lawson JH, Hemostasis Summit Participants: Multidisciplinary approach to the chal- lenge of hemostasis. Anesth Analg 2010; 110:354 -64
  2. [11]11. Luddington RJ: Thrombelastography/thromboelastometry. Clin Lab Haematol 2005; 27:81-90
  3. [15]15. The Board of the German Medical Association on the Rec- ommendation of the Scientific Advisory Board: Cross-sec- tional guidelines for therapy with blood components and plasma derivatives(4th revised edition). Transfus Med He- mother 2009; 36:351-482
  4. [17]17. Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, Royston BD, Bridges CR, Higgins RS, Despotis G, Brown JR, Society of Cardiovascular Anesthesiologists Spe- cial Task Force on Blood Transfusion, Spiess BD, Shore- Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S: Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiolo- gists clinical practice guideline. Ann Thorac Surg 2007; 83: S27-86
  5. [18]18. Napolitano LM, Kurek S, Luchette FA, Corwin HL, Barie PS, Tisherman SA, Hebert PC, Anderson GL, Bard MR, Bromberg W, Chiu WC, Cipolle MD, Clancy KD, Diebel L, Hoff WS, Hughes KM, Munshi I, Nayduch D, Sandhu R, Yelon JA; American College of Critical Care Medicine of the Society of Critical Care Medicine; Eastern Association for the Surgery of Trauma Practice Management Workgroup: Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care. Crit Care Med 2009;37: 3124 -57
  6. [19]19. Go ¨rlinger K, Dirkmann D, Weber CF, Rahe-Meyer N, Hanke AA: Algorithms for transfusion and coagulation management in massive haemorrhage. Ana ¨sth Intensivmed 2011; 52: 145-59
  7. [27]27. Snyder-Ramos SA, Mo ¨hnle P, Weng YS, Bo ¨ttiger BW, Kulier A, Levin J, Mangano DT; Investigators of the Multicenter Study of Perioperative Ischemia; MCSPI Research Group: The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion 2008; 48:1284 -99
  8. [32]32. Kozek-Langenecker SA: Perioperative coagulation monitor- ing. Best Pract Res Clin Anaesthesiol 2010; 24:27-40

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Metadata

Authors
Weber, C. F., Görlinger, K., Meininger, D., Herrmann, E., Bingold, T., Moritz, A., Cohn, L. H., & Zacharowski, K.
Affiliations
  • University Hospital Frankfurt (DE)
  • Essen University Hospital (DE)
  • Goethe University Frankfurt (DE)
  • Brigham and Women's Hospital (US)
Venue
Anesthesiology
Published
2012-09-01
Volume
117
Issue
3
Pages
531-547
ISSN
0003-3022 (ISSN-L)
OpenAlex
W2033421420
Cited by
625
References
41
Citations by year
2026: 14 · 2025: 23 · 2024: 30 · 2023: 32 · 2022: 25 · 2021: 35 · 2020: 49 · 2019: 53 · 2018: 41 · 2017: 52 · 2016: 64 · 2015: 59 · 2014: 70 · 2013: 65 · 2012: 12
FWCI
46.10
Type
journal article
Language
en
Open access
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hematology › 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
point-of-care testing, hemostatic therapy, cardiac surgery, coagulopathy, thromboelastometry, impedance aggregometry, red blood cell transfusion, postoperative blood loss, heparin reversal, blood product transfusion, postoperative bleeding
MeSH terms
Aged, Cardiopulmonary Bypass, Female, Fibrinogen, Cardiac Surgical Procedures, Hemostatics, Humans, Male, Middle Aged, Prospective Studies, Factor VIIa, Erythrocyte Transfusion, Point-of-Care Systems

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