In patients who undergo cardiac surgery, severe perioperative bleeding and its treatment are often associated with increases in major cardiac and non-cardiac adverse events and greater mortality. A study from the September issue of Anesthesiology determined certain blood clotting treatment algorithms helped decrease blood transfusion requirements in cardiac surgery patients and were associated with improved outcomes and hospital cost-savings.
The study used specific bedside testing -- so called "point-of-care testing," -- to examine the function of components of the blood clotting cascade, as well as platelet function to supplement clinical judgment in deciding on the best treatment. If abnormalities were detected, blood clotting components that were deficient were corrected based on treatment algorithms.
"We wanted to find the safest and most efficient way to provide hemostasic, or blood clotting, interventions in cardiac patients," said corresponding study author Klaus Görlinger, M.D. "Our clinical trial of 100 patients analyzed the effectiveness of blood clotting treatment algorithms based on point-of-care testing combined with administration of specific coagulation factor concentrates such as fibrinogen and prothrombin complex concentrate."
The study from the Goethe-University Hospital Frankfurt, Germany found blood clotting treatment algorithms for point-of-care testing compared to conventional laboratory analyses not only decreased blood transfusion requirements in cardiac surgery patients, but also were associated with improved outcomes, including decreased incidences of adverse events such as acute lung injury, renal failure, sepsis and thromboembolic complications. Participants also had decreased six-month mortality and reduced hospital costs.
The results of the randomized clinical trial confirmed the results of an earlier study in 3,865 patients undergoing cardiovascular surgery at University Hospital Essen, Germany before and after implementation of coagulation management algorithms based on point-of-care testing.
"Since the study was conducted in Europe, it cannot necessarily be applied to the U.S. without restrictions," said Dr. Görlinger. "However, our research demonstrating the medical and economic benefits is worth replicating in the U.S. in an attempt to help Americans receive more effective, safe and cost-saving management of severe perioperative bleeding."