title: The effectiveness of 10 years of interventions to control postoperative bleeding in adult cardiac surgery.
abstract: Postoperative bleeding in cardiac surgery remains an important complication, leading to increased morbidity and mortality. Different interventions are possible to prevent/treat postoperative bleeding. The present study aims to investigate the effectiveness of these interventions in a real-world scenario.
  
  
  
  This is a retrospective study based on 19 670 consecutive adult cardiac surgery patients operated from 2000 to 2015. During the study period, the following interventions have been applied and tested for effectiveness with a before versus after analysis: thromboelastography (TEG)-based diagnosis and treatment in actively bleeding patients; platelet function tests (PFTs); timing of surgery based on PFTs; fresh frozen plasma (FFP)-free strategy using prothrombin complex concentrate and fibrinogen concentrate.
  
  
  
  TEG-based diagnostic and therapeutic approach resulted in a significant (P = 0.006) reduction of postoperative bleeding and significant (P = 0.001) increase in platelet concentrate transfusion rate. Timing of surgery based on PFTs resulted in a significant reduction of postoperative bleeding (P = 0.001), surgical re-exploration rate (P = 0.002), FFP (P = 0.001) and platelet concentrate (P = 0.016) transfusion rate. FFP-free strategy was associated with a significant decrease in postoperative bleeding (P = 0.005) and FFP transfusions (P = 0.001). The combination of all the interventions was associated with a significant (P = 0.001) reduction in postoperative bleeding, surgical re-exploration rate and FFP transfusions, whereas platelet concentrate transfusion rate was significantly (P = 0.001) higher.
  
  
  
  Despite a continuous increase in the bleeding risk profile, the application of a bundle of interventions is effective in controlling postoperative bleeding and related complications. Platelet transfusions remain unreplaceable in the present scenario.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Baryshnikova
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pistuddi
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
mesh_terms: D000368:Aged; D001779:Blood Coagulation Factors; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002985:Clinical Protocols; D005260:Female; D005340:Fibrinogen; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D013916:Thrombelastography; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D005340:Fibrinogen
keywords: Blood transfusions; Cardiac surgical procedures; Haemorrhage