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Intraoperative Hemostatic Agents in Thoracic Aortic Surgery-A Scoping Review
Maite M T van Haeren1,2, Caitlin Bozic1, Jennifer S Breel1
1Department of Anesthesiology, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands.
Journal of Clinical Medicine
|June 13, 2025
Summary
Limited evidence exists for hemostatic agents in thoracic aortic surgery. Antifibrinolytics, factor eight inhibitor bypassing activity (FEIBA), and fibrinogen may help bleeding patients, but more research is needed.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Open thoracic aortic surgery has high bleeding complication rates.
- Coagulation management research often overlooks thoracic aortic surgery.
- This review assesses hemostatic agents for this patient group.
Purpose of the Study:
- To evaluate current evidence on intraoperative hemostatic agents.
- To determine their effect on bleeding and blood transfusions in thoracic aortic surgery.
- To identify gaps in research for optimal coagulation management.
Main Methods:
- Scoping review of MEDLINE, Embase, and Cochrane Library.
- Included randomized controlled trials and observational studies with comparisons.
- Focused on thoracic aortic surgery, excluding specific types.
Main Results:
- 33 studies analyzed antifibrinolytics, fibrinogen, rFVIIa, blood products, and FEIBA.
- Evidence for blood products is unclear; FEIBA may reduce use in aortic dissection.
- Fibrinogen data is mixed; antifibrinolytics show potential but results conflict.
Conclusions:
- Evidence on hemostatic agents in thoracic aortic surgery is limited.
- Antifibrinolytics, FEIBA, and fibrinogen may benefit specific bleeding patients.
- High-quality RCTs are needed for optimal coagulation management strategies.
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