Avoiding coagulopathy in vascular surgery.
The possibility of coagulopathy can be minimized by attending to certain general perioperative details to avoid hypothermia, hypotension-shock, and multiple transfusions. In this paper, we present our protocol for avoiding coagulopathy in vascular surgery. In the past 1 1/2 years, we have used perioperative plasmapheresis in 204 patients undergoing cardiac or aortic peripheral vascular surgery. Autologous platelet-rich plasma is transfused at the completion of the operation after heparin reversal. Our data show an approximate 50% reduction in homologous blood product requirement. Seventy-five percent of patients having aortic surgery received no homologous blood products during their hospital stay. For those undergoing cardiac surgery, there has been about a 45% reduction in the use of homologous blood products. In our experience, autologous platelet-rich plasma not only decreases the risk of transmittable disease, but promotes hemostasis.
Tawes
R L
RL
Peninsula Vascular Surgery Associates, Burlingame, California 94010.
Sydorak
G R
GR
Duvall
T B
TB
Scribner
R G
RG
Rosenman
J E
JE
Beare
J P
JP
Harris
E J
EJ
D001777:Blood Coagulation / Q000187:drug effects; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000379:methods; D003029:Coagulants / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D007035:Hypothermia / Q000517:prevention & control; D010865:Pilot Projects; D010956:Plasmapheresis / Q000295:instrumentation / Q000379:methods; D012773:Shock, Surgical / Q000517:prevention & control; D014656:Vascular Surgical Procedures / Q000379:methods*
D003029:Coagulants; D006493:Heparin