Anticoagulation, bleeding and blood transfusion practices in australasian cardiac surgical practice

• Published in: Anaesthesia and intensive care Vol. 35; no. 5; pp. 760 - 768
• Main Authors: DALY, D. J, MYLES, P. S, SMITH, J. A, KNIGHT, J. L, CLAVISI, O, BAIN, D. L, GLEW, R, GIBBS, N. M, MERRY, A. F
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01.10.2007; Sage Publications Ltd. (UK); Sage Publications Ltd
• Subjects: Aged; Aggregation; Anesthesia; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiologists; Antifibrinolytic Agents; Australasia; Biological and medical sciences; Blood Coagulation Disorders - prevention & control; Blood Component Transfusion - statistics & numerical data; Blood platelets; Blood transfusion; Blood Transfusion - statistics & numerical data; Cardiac Surgical Procedures - statistics & numerical data; Dosage and administration; Erythrocyte Transfusion - statistics & numerical data; Female; Health Care Surveys; Heart; Hemoglobins - analysis; Hemorrhage - epidemiology; Hemorrhage - therapy; Humans; Male; Medical sciences; Methods; Middle Aged; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Practice; Practice Guidelines as Topic; Prospective Studies; Reoperation; Risk Factors; Surgery; Australia; blood transfusion; Transfusion; bleeding; anticoagulation; Red blood cell; Anesthesia; Antifibrinolytic; Hemorrhage; antiplatelet; Antiplatelet agent; red cells
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057x0703500516

We surveyed contemporary Australasian cardiac surgical and anaesthetic practice, focusing on antiplatelet and antifibrinolytic therapies and blood transfusion practices. The cohort included 499 sequential adult cardiac surgical patients in 12 Australasian teaching hospitals. A total of 282 (57%) patients received red cell or component transfusion. The median (IQR) red cell transfusion threshold haemogloblin levels were 66 (61-73) g/l intraoperatively and 79 (74-85) g/l postoperatively. Many (40%) patients had aspirin within five days of surgery but this was not associated with blood loss or transfusion; 15% had clopidogrel within seven days of surgery. In all, 30 patients (6%) required surgical re-exploration for bleeding. Factors associated with transfusion and excessive bleeding include pre-existing renal impairment, preoperative clopidogrel therapy, and complex or emergency surgery. Despite frequent (67%) use of antifibrinolytic therapy, there was a marked variability in red cell transfusion rates between centres (range 17 to 79%, P < 0.001). This suggests opportunities for improvement in implementation of guidelines and effective blood-sparing interventions. Many patients presenting for surgery receive antiplatelet and/or antifibrinolytic therapy, yet the subsequent benefits and risks remain unclear.