title: Implementation of an institutional protocol for rational use of blood products and its impact on postoperative of coronary artery bypass graft surgery.
abstract: OBJECTIVE
  Cardiac surgeries are sometimes followed by significant blood loss, and blood transfusions may be necessary. However, indiscriminant use of blood components can result in detrimental effects for the patient. We evaluated the short-term effects of implementation of a protocol for the rational use of blood products in the perioperative period of cardiac surgery.
  
  
  METHODS
  Between April and June 2011, an institutional protocol was implemented in a private hospital specializing in cardiology to encourage rational use of blood products, with the consent and collaboration of seven cardiac surgery teams. We collected clinical and demographic data on the patients. The use of blood products and clinical outcomes were analyzed during hospital stay before and after protocol implementation. The protocol consisted of an institutional campaign with an educational intervention to surgical and anesthesiology teams; the goal was to tailor blood transfusion practice according to clinical goals (anemia with hemodynamic changes and significant ventricular dysfunction) and to make routine the prescription of ε-aminocaproic acid intraoperatively, which is recommended by international guidelines based on scientific evidence.
  
  
  RESULTS
  After three months of protocol implementation, the use of ε-aminocaproic acid increased from 31% to 100%. A total of 67% of surgeries before protocol implementation required any blood transfusion, compared with 40% that required any blood transfusion after protocol implementation in subsequent months of the same year (p<0.001). There was no significant difference in clinical outcomes assessed before and after implementation of the protocol.
  
  
  CONCLUSIONS
  The rational use of blood products associated with infusion of ε-aminocaproic acid has the potential to reduce the number of blood transfusions in perioperative of cardiac surgeries, but it can affect the risk of complications.
authors.forename: Pedro Gabriel Melo de Barros E
authors.initials: PG
authors.lastname: Silva
authors.forename: Dimas Tadahiro
authors.initials: DT
authors.lastname: Ikeoka
authors.forename: Viviane Aparecida
authors.initials: VA
authors.lastname: Fernandes
authors.forename: Nilza Sandra
authors.initials: NS
authors.lastname: Lasta
authors.forename: Debora Prudencio E
authors.initials: DP
authors.lastname: Silva
authors.forename: Mariana Yumi
authors.initials: MY
authors.lastname: Okada
authors.forename: Beatriz Akinaga
authors.initials: BA
authors.lastname: Izidoro
authors.forename: José Carlos Teixeira
authors.initials: JC
authors.lastname: Garcia
authors.forename: Antonio Claudio do Amaral
authors.initials: AC
authors.lastname: Baruzzi
authors.forename: Valter
authors.initials: V
authors.lastname: Furlan
mesh_terms: D015119:Aminocaproic Acid / Q000008:administration & dosage; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid