title: Anticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice.
abstract: 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.
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Cardiothoracic Unit, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Daly
authors.forename: P S
authors.initials: PS
authors.lastname: Myles
authors.forename: J A
authors.initials: JA
authors.lastname: Smith
authors.forename: J L
authors.initials: JL
authors.lastname: Knight
authors.forename: O
authors.initials: O
authors.lastname: Clavisi
authors.forename: D L
authors.initials: DL
authors.lastname: Bain
authors.forename: R
authors.initials: R
authors.lastname: Glew
authors.forename: N M
authors.initials: NM
authors.lastname: Gibbs
authors.forename: A E
authors.initials: AE
authors.lastname: Merry
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D000933:Antifibrinolytic Agents; D044362:Australasia; D001778:Blood Coagulation Disorders / Q000517:prevention & control*; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors