Transfus Apher Sci. 2019 Jun 25. pii: S1473-0502(19)30108-9. doi: 10.1016/j.transci.2019.06.015. [Epub ahead of print]

Patient blood management in the cardiac surgical setting: An updated overview

Terwindt LE¹, Karlas AA¹, Eberl S¹, Wijnberge M¹, Driessen AHG¹, Veelo DP¹, Geerts BF¹, Hollmann MW¹, Vlaar APJ².

^{1 Dept. of Anesthesiology, Academic Medical Center, University of Amsterdam, the Netherlands; Dept. of Intensive Care, Academic Medical Center, University of Amsterdam, the Netherlands.}

^{2 Dept. of Anesthesiology, Academic Medical Center, University of Amsterdam, the Netherlands; Dept. of Intensive Care, Academic Medical Center, University of Amsterdam, the Netherlands. Electronic address: a.p.vlaar@amc.uva.nl.}

Abstract

In cardiac surgical patients it is a complex challenge to find the ideal balance between anticoagulation and hemostasis. Preoperative anemia and perioperative higher transfusion rates are related to increased morbidity and mortality. Patient blood management (PBM) is an evidence based patient specific individualized protocol used in the perioperative setting in order to reduce perioperative bleeding and transfusion rates and to improve patient outcomes. The three pillars of PBM in cardiac surgery consist of optimization of preoperative erythropoiesis and hemostasis, minimizing blood loss, and improving patient specific physiological reserves. This narrative review focuses on the challenges with special emphasis on PBM in the preoperative phase and intraoperative transfusion management and hemostasis in cardiac surgery patients. It is a “must” that PBM is a collaborative effort between anesthesiologists, surgeons, perfusionists, intensivists and transfusion laboratory teams. This review represents an up to date overview over “PBM in cardiac surgery patients”.

KEYWORDS: Anticoagulation; Blood transfusion; Cardiac surgery; Coagulation factors; Fibrinogen; Hemostasis; Point of care tests; Prothrombin complex concentrates; Transfusion thresholds