door study includes data from over eight
thousand cardiac surgery patients a year as
your pittsburgh medical center
shall we looked at patients who received
non pack red blood cell blood products
such as that platelets fresh frozen plasma
inquired precipitate after heart surgery
and compared those patients that those that
did not receive what products and will
we found with that was that there
is no significant difference in post operative
mortality or thirty day mortality there's no
difference and reaffirmation for bleeding and really
no major difference in morbidities after archer
was also interesting was that on follow
up we noticed that there is no
significant difference in long term survival
so in summary with these data suggest
that patients who are undergoing cardiac surgery
who would receive blood products alone without
red blood cell transfusion do not have
an associated increase in short or long
term out
chill one of the most common questions
we get is what is our transfusion
threshold and so that depends on if
we're looking at your pack red blood
cells versus all the non pack red
blood cells product so for blood transfusion
are packed red blood cells be typically
transfuse after a cardiac surgery we have
a threshold
have a hemoglobin under seven or and
unstable patient with active bleeding under hemoglobin
of eight
in
there's a little bit of variability as
you would expect from other shatters we
have a slightly restrictive transfusion criterion because
we published in the past based on
our experience of fusing pack red blood
cells may increase short or long and
long from mortality
when it comes to not packard blood
sell products such as cried precipitate fresh
frozen plasma and platelets we transfused him
and slightly more liberal when we are
offering and patients were on actively on
anti platelets such as plavix are on
other no actual go act and patients
or and
undergoing urgent archer
joke but again it all depends on
individual clinical situation
including the quantity and quality of bleeding
in the operating room after a court
appointed by past or in the i
you and we really use a a
complete multi display holistic model to ensure
that you know between cardigan seizure cardiac
surgery in critical care medicine there would
be appropriate to transfuse pitched
should these data are you know answered
important clinical quest and because his critics
rudeness we are asked young not infrequently
to operate on urgent patients who undergo
heart surgery or for instance a patient
who may have had a recent and
stem your stomach it was perhaps loaded
with plavix or belinda
a patient who comes in or than
a cute aortic dissection who may be
on a know accurate door and so
there's a hesitancy by some surgeons to
not operate on these creatures because of
a very high risk for bleeding or
the alternative pathway or the offered of
thought would be to consider operating on
these patients and be a little bit
more aggressive about
correcting the quack elop la the my
trance using products such as platelets cry
precipitate fresh and flat spot
we have one of the largest data
we were the largest series now that
demonstrates that it may be safe to
be able to do so as this
does not appear to reduce survival in
the short or long term following cardiac
surgery
you don't want to the limitations of
the study as you can imagine is
that it is a retrospective study it
is a single as to should stay
and so you know that to answer
a question like this really needs a
prospective multicenter trial
that would allow us to determine if
it would be saved in the short
and long term to have patients received
blood products
and not affect survival
an interpreter realize that there are some
nuance in or decision making regarding when
patient get a pack red bledsoe blood
transfusions and what patient get not packard
blood red blood cell blood products without
blood transfusion although it a little bit
difficult to capture the subtleties like decision
making and in stuff
he's like this at it is likely
that patients the require urgent blood transfusion
are inherently more unstable at which may
play a role in the known an
association between blood transfusions and worst survival
in cardiac surgery
i think when cardiologists could benefit from
is that if a patient may have
a higher risk of perry operative bleeding
it is reasonable to confer with the
surgeon and plan for urgent surgery when
indicated with a plan to transfuse non
packard blood cell blood products or
for surgery