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Perioperative haemostasis and coagulation management in cardiac surgery: a European survey

Published online by Cambridge University Press:  01 June 2007

M. Ranucci
M. Ranucci*
Affiliation:
Cardiothoracic Anaesthesia and Intensive Care Department, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy
*
Correspondence to: Marco Ranucci, Head Cardiothoracic Anesthesia Dept, IRCCS Policlinico S. Donato, Via Morandi 30, 20097 San Donato Milanese, Milan (Italy). E-mail: cardioanestesia@virgilio.it; Tel: +39 02 52774320, Fax: +39 02 55602262
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Summary

Background and objectives

During the last decade many aspects of haemostasis and coagulation management greatly changed in cardiac surgery. On one side, new anti-platelet agents entered the market and became more and more widely used; on the other one, point-of-care monitoring tools are nowadays available for perioperative use. The present survey is aimed to investigate the perioperative haemostasis and coagulation management in European Cardiac Surgery Institutions.

Methods

A questionnaire exploring different aspects of perioperative haemostasis and coagulation management was sent to 320 Cardiac Surgery Institutions in Europe.

Results

82 Institutions replied to the survey. Due to the poor quality of the data collection, 9 Institutions were excluded. A pool of 73 questionnaires coming from 24 different Countries was analyzed. Non-routine coagulation tests (antithrombin activity) are done in 34% of the Institutions before the operation and in 23% after the operation. Point-of-care tests are applied as a preoperative routine in 9.9% of the Institutions (thromboelastography, 5.7%; PFA-100, 1.4%; others, 2.8%) and in selected patients in 50% of the Institutions. Postoperative point-of-care test are applied in 17.9% of the Institutions (thromboelastography, 2.7%; PFA-100, 1.4%; others, 13.8%). Allogeneic blood products use widely differs among Institution: packed red cells are used in 47.5% of the patients (range 8%–90%), fresh frozen plasma in 29% (2%–100%) and platelets in 12.4% (0%–50%).

Conclusions

Perioperative haemostasis and coagulation management is widely different among European Institutions. Point-of-care coagulation and platelet function tests are gaining a significant role. Transfusional policy appears strongly Institution-dependent.

Keywords

CoagulationTransfusionsCardiac surgery
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 1 - 13
Copyright
Copyright © European Society of Anaesthesiology 2007

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