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Journal of Vascular Surgery Mar 2022Thromboelastography (TEG) is diagnostic modality that analyzes real-time blood coagulation parameters. Clinically, TEG primarily allows for directed blood component...
OBJECTIVE
Thromboelastography (TEG) is diagnostic modality that analyzes real-time blood coagulation parameters. Clinically, TEG primarily allows for directed blood component resuscitation among patients with acute blood loss and coagulopathy. The utilization of TEG has been widely adopted in among other surgical specialties; however, its use in vascular surgery is less prominent. We aimed to provide an up-to-date review of TEG utilization in vascular and endovascular surgery.
METHODS
Using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a literature review with the Medical Subject Headings (MeSH) terms "TEG and arterial events", "TEG and vascular surgery", "TEG and vascular", "TEG and endovascular surgery", "TEG and endovascular", "TEG and peripheral artery disease", "TEG and prediction of arterial events", "TEG and prediction of complications ", "TEG and prediction of thrombosis", "TEG and prediction of amputation", and "TEG and amputation" was performed in Cochrane and PubMed databases to identify all peer-reviewed studies of TEG utilization in vascular surgery, written between 2000 and 2021 in the English language. The free-text and MeSH subheadings search terms included diagnosis, complications, physiopathology, surgery, mortality, and therapy to further restrict the articles. Studies were excluded if they were not in humans or pertaining to vascular or endovascular surgery. Additionally, case reports and studies with limited information regarding TEG utilization were excluded. Each study was independently reviewed by two researchers to assess for eligibility.
RESULTS
Of the 262 studies identified through the MeSH strategy, 15 studies met inclusion criteria and were reviewed and summarized. Literature on TEG utilization in vascular surgery spanned cerebrovascular disease (n = 3), peripheral arterial disease (n = 3), arteriovenous malformations (n = 1), venous thromboembolic events (n = 7), and perioperative bleeding and transfusion (n = 1). In cerebrovascular disease, TEG may predict the presence and stability of carotid plaques, analyze platelet function before carotid stenting, and compare efficacy of antiplatelet therapy after stent deployment. In peripheral arterial disease, TEG has been used to predict disease severity and analyze the impact of contrast on coagulation parameters. In venous disease, TEG may predict hypercoagulability and thromboembolic events among various patient populations. Finally, TEG can be utilized in the postoperative setting to predict hemorrhage and transfusion requirements.
CONCLUSIONS
This systematic review provides an up-to-date summarization of TEG utilization in multiple facets of vascular and endovascular surgery.
Topics: Blood Coagulation; Blood Loss, Surgical; Blood Transfusion; Endovascular Procedures; Humans; Monitoring, Intraoperative; Postoperative Hemorrhage; Predictive Value of Tests; Thrombelastography; Treatment Outcome; Vascular Diseases; Vascular Surgical Procedures
PubMed: 34788649
DOI: 10.1016/j.jvs.2021.11.037 -
Danish Medical Journal May 2017Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether it is necessary to discontinue fish oil supplementation prior to surgery.
METHODS
Studies were identified through PubMed and Embase searches and by reviewing the reference lists of the included papers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Included in the review were publications including a minimum of 20 healthy subjects and studies on patients who were undergoing surgery and who had fish oil exposure.
RESULTS
In total, 52 publications were included; 32 publications on healthy subjects and 20 publications on patients undergoing surgery. The majority of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery.
CONCLUSION
Fish oil supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior to surgery or other invasive procedures.
Topics: Blood Loss, Surgical; Dietary Supplements; Fish Oils; Humans; Postoperative Hemorrhage; Randomized Controlled Trials as Topic; Risk Assessment
PubMed: 28552094
DOI: No ID Found -
Cardiovascular Journal of AfricaPlatelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis...
BACKGROUND
Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), and to examine their relationship with postoperative bleeding and blood transfusion.
METHODS
One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. All CABGs were performed by the same surgical team in a standardised method, utilising the on-pump technique. IPC, MPV and IPF were measured pre-operatively, after the completion of surgery, and at the postoperative first, third and fifth days. The primary outcome measure of this study was whether the need for transfusion was associated with IP, IPF, MPV and platelet count.
RESULTS
There was a significant decrease of 7.77% in IPC on the day of the operation. Pre-operative IPC and IPF were correlated with postoperative drainage ( < 0.001), intraoperative blood transfusion ( < 0.001) and intensive care unit blood transfusion ( < 0.001). Pre-operative haemoglobin levels were significantly correlated with length of hospital stay. However, neither pre-operative IPC nor IPF were associated with length of hospital stay. Postoperative IPC was however associated with the length of hospital and intensive care unit stay ( = 0.008 and = 0.009, respectively).
CONCLUSIONS
Pre-operative IPC and IPF were significantly correlated with postoperative drainage and blood transfusion frequency. In patients undergoing CABG, these can be seen as serious guiding parameters in the estimation of postoperative bleeding.
Topics: Blood Transfusion; Coronary Artery Bypass; Humans; Mean Platelet Volume; Platelet Count; Postoperative Hemorrhage; Prospective Studies
PubMed: 34546284
DOI: 10.5830/CVJA-2021-041 -
The Annals of Thoracic Surgery Aug 2013
Topics: Anemia; Blood Transfusion; Cardiac Surgical Procedures; Female; Humans; Male; Postoperative Hemorrhage
PubMed: 23910102
DOI: 10.1016/j.athoracsur.2013.05.009 -
HPB : the Official Journal of the... Nov 2014This study aimed to explore the incidence and causes of intra-abdominal haemorrhage after hepatectomy, indications for re-exploration, and factors affecting occurrence.
OBJECTIVES
This study aimed to explore the incidence and causes of intra-abdominal haemorrhage after hepatectomy, indications for re-exploration, and factors affecting occurrence.
METHODS
Clinical data for 77 patients (0.2% of 32 856 hepatectomy patients) submitted to re-exploration for haemorrhage following hepatectomy for primary liver cancer (PLC) from 2001 to 2010 were retrospectively reviewed and analysed for postoperative complications, potential site and cause of bleeding.
RESULTS
The median interval between hepatectomy and re-exploration was 23 h in the 77 patients (range: 1 h to 11 days). Re-exploration occurred within 24 h after hepatectomy in 64 patients (83.1%), and within 8 h in 37 patients (48.1%). The most common anatomic site of intra-abdominal haemorrhage was the cut surface of the liver (n = 51, 66.2%), followed by the perihepatic ligaments (n = 19, 24.7%), the splenic fossa (n = 7, 9.1%), the diaphragm (n = 6, 7.8%), the retroperitonium (n = 6, 7.8%), the right adrenal gland (n = 3, 3.9%), and the gallbladder bed (n = 2, 2.6%). The most common form of bleeding was oozing. Early haemorrhage (at ≤ 24 h) was most likely to occur in the form of venous bleeding or oozing from the cut surface of the liver. Rates of 5-year overall and disease-free survival in the 77 patients were 22.1% and 3.9%, respectively.
CONCLUSIONS
Re-exploration for haemorrhage following hepatectomy for PLC is a rare event. Haemorrhage occurs predominantly at the cut parenchymal surface. Early return to the operating room is vital and perioperative survival is common in this high-risk group.
Topics: Adolescent; Adult; Aged; China; Disease-Free Survival; Female; Hepatectomy; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Hemorrhage; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 25040621
DOI: 10.1111/hpb.12255 -
Journal of Orthopaedics and... Jul 2019Total knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
Total knee arthroplasty (TKA) surgery can be associated with significant blood loss. Among the problems associated with such blood loss is the need for transfusions of banked blood [1]. Transfusions not only have a financial consequence but also carry a small risk of disease transmission to the patient. Antifibrinolytics have been successfully used to reduce transfusion requirements in elective arthroplasty patients. The objective of this meta-analysis is to determine which of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) is more effective for reducing peri-operative blood loss, and lessening the need for blood transfusion following knee arthroplasty surgery.
MATERIALS AND METHODS
MEDLINE, Embase and CINAHL databases were searched for relevant articles published between January 1980 to January 2018 for the purpose of identifying studies comparing TXA and EACA for TKA surgery. A double-extraction technique was used, and included studies were assessed regarding their methodological quality prior to analysis. Outcomes analysed included blood loss, pre- and post-operative haemoglobin, number of patients requiring transfusion, number of units transfused, operative and tourniquet time, and complications associated with antifibrinolytics.
RESULTS
Three studies contributed to the quantitative analysis of 1691 patients, with 743 patients included in the TXA group and 948 in the EACA group. Estimated blood loss was similar between the two groups [95% confidence interval (CI) -0.50, 0.04; Z = 1.69; P = 0.09]. There were no differences between the two groups regarding the percentage of patients requiring transfusion (95% CI 0.14, 4.13; Z = 0.31; P = 0.76). There was no difference in the pre- and post-operative haemoglobin difference between the two groups (95% CI -0.36, 0.24; Z = 0.38; P = 0.70). There was no difference in the average number of transfused units (95% CI -0.53, 0.25; Z = 0.71; P = 0.48). There was no difference in the operative (95% CI -0.35, 0.36; Z = 0.04; P = 0.97) or tourniquet time (95% CI -0.16, 0.34; Z = 0.72; P = 0.47). Similarly, there was no difference in the percentage of venous thromboembolism between the two groups (95% CI 0.17, 2.80; Z = 0.51; P = 0.61).
CONCLUSIONS
This study did not demonstrate TXA to be superior to EACA. In fact, both antifibrinolytic therapies demonstrated similar efficacy in terms of intra-operative blood loss, transfusion requirements and complication rates. Currently EACA has a lower cost, which makes it an appealing alternative to TXA for TKA surgery.
LEVEL OF EVIDENCE
3.
Topics: Aminocaproic Acid; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Male; Postoperative Hemorrhage; Tranexamic Acid; Venous Thromboembolism
PubMed: 31321578
DOI: 10.1186/s10195-019-0534-2 -
Journal of Cardiothoracic and Vascular... Feb 2018The aim was to evaluate the predictive value of thromboelastometry for postoperative blood loss in adult cardiac surgery with cardiopulmonary bypass. (Review)
Review
OBJECTIVE
The aim was to evaluate the predictive value of thromboelastometry for postoperative blood loss in adult cardiac surgery with cardiopulmonary bypass.
DESIGN
Retrospective cohort study and systematic review of the literature.
SETTING
A tertiary university hospital.
PARTICIPANTS
202 patients undergoing elective cardiac surgery.
INTERVENTIONS
Thromboelastometry was performed before cardiopulmonary bypass and 3 minutes after protamine administration.
MEASUREMENTS AND MAIN RESULTS
The cohort study showed that the preoperative and postoperative thromboelastometric positive predicting value was poor (0%-22%); however, the negative predicting value was high (89%-94%). The systematic review of the literature to evaluate the predictive value of thromboelastometry for major postoperative bleeding in cardiac surgery resulted in 1,311 articles, 11 of which were eligible (n = 1,765; PubMed and Embase, until June 2016). Two studies found a good predictive value, whereas the other 9 studies showed a poor predictability for major postoperative bleeding after cardiac surgery. The overall negative predicting value was high.
CONCLUSIONS
Thromboelastometry does not predict which patients are at risk for major postoperative bleeding.
Topics: Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Cohort Studies; Humans; Middle Aged; Postoperative Hemorrhage; Predictive Value of Tests; Retrospective Studies; Thrombelastography
PubMed: 29126688
DOI: 10.1053/j.jvca.2017.08.025 -
Joint Diseases and Related Surgery 2020This study aims to investigate if tranexamic acid (TXA) reduces both visible and hidden blood loss in patients undergoing total knee arthroplasty (TKA).
OBJECTIVES
This study aims to investigate if tranexamic acid (TXA) reduces both visible and hidden blood loss in patients undergoing total knee arthroplasty (TKA).
PATIENTS AND METHODS
A total of 128 female patients (mean age 68.9±5.8 years; range, 55 to 80 years) who underwent TKA and were admitted between January 2010 and January 2020 were included in this retrospective study. Only patients who had primary unilateral knee arthroplasty with a cemented posterior cruciate ligament substituting implant were included. Patients were divided into two groups according to TXA administration in the perioperative period. Group 1 consisted of patients who did not receive TXA (n=69), while Group 2 consisted of patients who received TXA (n=59). The effect of TXA on visible and hidden blood loss, amount of erythrocyte suspension transfusions, postoperative early wound complications, and the relationship between the volume of hidden blood loss and drainage volume were detected.
RESULTS
There was no statistically significant difference between the groups in terms of age, body mass index, operation side, preoperative hematocrit (HCT) values, and total blood volume. Postoperative HCT values were statistically higher in Group 2. Fifty-four units of erythrocyte suspension transfusion were required in Group 1, while six units were required in Group 2 (p<0.001). Early wound complication was determined in 10 patients in Group 1 and only in one patient in Group 2 (p=0.011). Intraoperative blood loss, postoperative drainage volume, hidden blood loss, and total blood loss values were significantly lower in Group 2 (p=0.001). In all patients, there was a significant positive correlation between the postoperative drainage volume and the hidden blood loss volume (r=0.532, p=0.001).
CONCLUSION
The use of TXA in patients undergoing TKA reduces postoperative bleeding (visible and hidden blood loss), blood transfusion needs, and early wound complications. In addition, drainage volume in postoperative 24 hours can be used to estimate the amount of hidden blood loss in early postoperative period.
Topics: Aged; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Component Transfusion; Blood Loss, Surgical; Blood Volume; Drainage; Female; Hematocrit; Humans; Postoperative Hemorrhage; Retrospective Studies; Tranexamic Acid; Treatment Outcome; Wound Healing
PubMed: 32962580
DOI: 10.5606/ehc.2020.78024 -
Journal of Thrombosis and Haemostasis :... Jan 2010The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity... (Review)
Review
The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its subcommittee on Control of Anticoagulation, of the International Society on Thrombosis and Haemostasis has previously published a recommendation for a harmonized definition of major bleeding in non-surgical studies. That definition has been adopted by the European Medicines Agency and is currently used in several non-surgical trials. A preliminary proposal for a parallel definition for surgical studies was presented at the 54(th) Annual Meeting of the SSC in Vienna, July 2008. Based on those discussions and further consultations with European and North American surgeons with experience from clinical trials a definition has been developed that should be applicable to all agents that interfere with hemostasis. The definition and the text that follows have been reviewed and approved by relevant co-chairs of the subcommittee and by the Executive Committee of the SSC. The intention is to seek approval of this definition from the regulatory authorities to enhance its incorporation into future clinical trial protocols.
Topics: Anticoagulants; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Fibrinolytic Agents; Hemoglobins; Humans; Postoperative Hemorrhage; Randomized Controlled Trials as Topic; Reoperation; Severity of Illness Index; Societies, Medical; Terminology as Topic; Time Factors
PubMed: 19878532
DOI: 10.1111/j.1538-7836.2009.03678.x -
British Journal of Anaesthesia May 2016Fibrinogen supplementation has been proposed both to prevent and treat postoperative bleeding in cardiac surgery. The optimal fibrinogen concentration trigger and target... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Fibrinogen supplementation has been proposed both to prevent and treat postoperative bleeding in cardiac surgery. The optimal fibrinogen concentration trigger and target values and the fibrinogen concentrate dose required remain uncertain. This subanalysis of data from the Zero-Plasma Trial (ZEPLAST) assessed target fibrinogen values and the corresponding fibrinogen concentrate dose for supplementation.
METHODS
We performed a post hoc analysis of 116 subjects included in the randomized, placebo-controlled ZEPLAST trail. Data considered were fibrin-based thromboelastometry (FIBTEM) maximum clot firmness (MCF) determined by whole-blood thromboelastometry (ROTEM) before and after placebo or fibrinogen concentrate, Clauss fibrinogen concentration after placebo or fibrinogen concentrate, postoperative bleeding and severe bleeding (SB). The association between FIBTEM MCF and Clauss fibrinogen concentration was tested with linear regression analyses. The predictive value for SB of FIBTEM MCF and Clauss fibrinogen concentration was tested with receiver operating characteristic analyses.
RESULTS
There was a good association between FIBTEM MCF and Clauss fibrinogen concentration in the baseline study population (r(2) = 0.66), which worsened in fibrinogen-supplemented subjects. Both FIBTEM MCF and Clauss fibrinogen concentration yielded a good discriminative power for SB (area under the curve 0.721 and 0.767, respectively). The negative predictive value for SB was 100% for a Clauss fibrinogen concentration of 287 mg dl(-1) and 98% for an FIBTEM MCF of 14 mm. Based on these newly defined target values, the dose of fibrinogen concentrate needed would be 3 g lower than the dose used in ZEPLAST.
CONCLUSIONS
A dose of fibrinogen concentrate rarely exceeding 2 g might be sufficient to prevent bleeding in cardiac surgery.
Topics: Aged; Blood Coagulation Tests; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Dose-Response Relationship, Drug; Fibrinogen; Humans; Platelet Count; Postoperative Hemorrhage; ROC Curve; Risk Factors; Thrombelastography
PubMed: 26893405
DOI: 10.1093/bja/aev539