[Survey of perioperative hemostasis and transfusion management in cardiac surgery: how do anesthesiologists practice?].
OBJECTIVE
To determine practices related to control of perioperative hemostasis and transfusion in patients undergoing cardiac surgery in Spain, including the extent to which protocols are being used.


METHODS
A questionnaire was created to collect information from physicians in anesthesiology and postoperative recovery care between July 1 and September 20, 2007. The physicians were asked about practice in the 12 months prior to the survey.


RESULTS
Thirty-four hospitals responded. Seventy percent reported that they did not have protocols or guidelines for the control of hemostasis during cardiac surgery. Forty-four percent did not have information on the proportion of patients who received transfusions; 47% gave transfusions to 75% of patients. The standard preoperative tests were platelet counts, activated partial thromboplastin time, and prothrombin time. Acetylsalicylic acid and clopidogrel were suspended before surgery at 15 (44%) and 25 (73%) hospitals, respectively. In cases of resistance to heparin, additional doses of the drug were injected, in combination with plasma or antithrombin in 29% and 12% of the hospitals, respectively. In the intensive postoperative recovery care unit, only 1 hospital used thromboelastography. Only 1 other hospital used a platelet function analyzer.


CONCLUSIONS
Hemostasis, perioperative coagulation, and criteria for transfusion vary widely among the hospitals surveyed. Few guidelines are available and they are not often being followed. A high percentage of patients receive transfusions, although not all hospitals can cite a figure. New technology has not been widely applied.
Basora
M
M
Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona. mbasora@clinic.ub.es
Fita
G
G
Panigua
P
P
Litvan
H
H
Fló
A
A
Reverter
J C
JC
D000776:Anesthesiology / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D003625:Data Collection; D004363:Drug Utilization / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006488:Hemostasis, Surgical / Q000379:methods / Q000706:statistics & numerical data; D006489:Hemostatic Techniques / Q000706:statistics & numerical data*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D011182:Postoperative Care / Q000592:standards / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000592:standards / Q000706:statistics & numerical data; D011997:Recovery Room; D013030:Spain; D011795:Surveys and Questionnaires
D000925:Anticoagulants; D006490:Hemostatics