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Reduction in requirements for allogeneic blood products: pharmacologic methods
M Janssens1, G Hartstein, J L David
1Department of Anesthesia and Intensive Care Medicine, University Hospital of Liège, Belgium.
The Annals of Thoracic Surgery
|December 1, 1996
Summary
Antifibrinolytic drugs effectively reduce bleeding and transfusion needs after open heart surgery. However, their routine prophylactic use is debated due to cost and potential thromboembolic complications.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Perioperative bleeding is a significant concern in cardiac surgery.
- Various pharmacologic agents, including prostacyclin, desmopressin, and antifibrinolytics, are used to manage bleeding.
Purpose of the Study:
- To review the literature on drugs used to reduce perioperative bleeding during cardiopulmonary bypass.
- To clarify indications, remaining questions, and future research directions for these agents.
Main Methods:
- Literature review of studies on prostacyclin, desmopressin, and antifibrinolytics in cardiopulmonary bypass operations.
Main Results:
- Prostacyclin mitigates platelet trauma but not postoperative bleeding. Desmopressin enhances platelet adhesion but isn't recommended for routine use. Antifibrinolytics (natural and synthetic) inhibit plasmin, reducing bleeding and transfusion needs post-cardiac surgery.
- Aprotinin may have minimal thromboembolic risk when used at sufficient concentrations to inhibit plasma kallikrein.
Conclusions:
- Prophylactic antifibrinolytics are effective in reducing bleeding and transfusion requirements.
- Routine use of antifibrinolytics is controversial due to economic factors and concerns about thromboembolic complications.