Tranexamic acid administration is not associated with an increase in complications in high-risk patients undergoing primary total knee or total hip arthroplasty: a retrospective case-control study of 38,220 patients.

This study was designed to examine whether tranexamic acid, which is a well-established therapy to reduce postoperative bleeding, is associated with adverse events in patients at high risk for a thrombotic event undergoing total joint arthroplasty (TJA). While there is good trial data supporting the use of tranexamic acid in “low-risk” patients undergoing TJA, the […]

NATA CME Webinar – How to manage iron deficiency anaemia in the surgical patient

The objective of this webinar is to provide an overview of the available evidence and practical recommendations on the management of perioperative iron deficiency anaemia. View the on-demand webinar Agenda Welcome and introduction Jens Meier, Linz, Austria Preoperative intravenous iron to treat anaemia before major abdominal surgery – the PREVENTT trial Andrew A. Klein, Cambridge, […]

Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic Acid in Open Cardiac Surgery (DEPOSITION) study: Results of a pilot study.

The authors performed a pilot study comparing topical versus intravenous administration of tranexamic acid. Given the heterogeneity of cardiac surgery patients, the lack of any difference in outcome between the two groups, in terms of chest tube drainage and transfusion requirement, does not infer any change in clinical practice. The authors underline that observations should […]

Lack of persistent microchimerism in contemporary transfused trauma patients.

Jackman and colleagues evaluated transfusion-associated microchimerism (TA-MC) in a prospective cohort study of trauma patients. Index samples were collected upon admission, prior to transfusion and at periodical intervals up to one year. TA-MC was detected by real-time quantitative allele-specific PCR assays at the HLA-DR locus and at several polymorphic insertion deletion sites screening for non-recipient […]

Transfusion practice in the non-bleeding critically ill: an international online survey-the TRACE survey.

In order to elucidate whether data from transfusion trials has impacted current intensive care transfusion management, de Bruin and colleagues performed an online, anonymous, worldwide survey among ICU physicians, evaluating red blood cell, platelet and plasma transfusion practices. Of 725 completed surveys, a hospital transfusion protocol was available in 53%, with only 29% using ICU-specific […]

Impact of multidisciplinary pulmonary embolism response team availability on management and outcomes.

Chaudhury et al. retrospectively analysed the outcomes of 769 consecutive adult patients with pulmonary embolism (PE) (as diagnosed by computed tomography PE protocol) for the 18 months prior to and after initiation of a multidisciplinary Pulmonary Embolism Response Team (PERT) in their large tertiary care centre. PERT-era patients had significantly lower rates of bleeding, shorter time-to-therapeutic anticoagulation, […]

The impact of pre-operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial.

In this follow-up of an open-label randomised controlled trial (designed to be pragmatic and applicable to current cancer treatment timelines, and powered to detect a difference in transfusion rates), the authors assessed the efficacy of intravenous ferric carboxymaltose (n = 42) vs. ferrous sulphate (n = 50), given at least two weeks preoperatively, in improving quality of life (QoL) […]

4-factor prothrombin complex concentrate is associated with improved survival in trauma related hemorrhage: a nationwide propensity matched analysis.

The authors conducted a retrospective study to evaluate outcomes of severely injured trauma patients who received 4-factor prothrombin complex concentrate (4-PCC) + fresh frozen plasma (FFP) compared to FPP alone. For this, they analysed two years (2015–2016) of the American College of Surgeons-Trauma Quality Improvement Program database. A large number of adult, seriously traumatised patients […]

Fibrinogen concentrate as an alternative to cryoprecipitate in a postcardiopulmonary transfusion algorithm in infants undergoing cardiac surgery: a prospective randomized controlled trial.

This is an excellent multicentre prospective randomised trial evaluating the efficacy of fibrinogen concentrate (FC) compared to cryoprecipitate to achieve haemostasis for infants post-cardiopulmonary bypass. The primary outcome was the difference in the number of intraoperative blood product transfusions. Secondary outcomes included 24-hour chest tube output, mechanical ventilation time, adverse events, intensive care unit length […]

A regional massive hemorrhage protocol developed through a modified Delphi technique.

The authors noted that large academic centres are very likely to have a massive haemorrhage protocol (MHP) but smaller non-academic hospitals may not. Using a Modified Delphi Method, they convened a group of experts to agree on evidence-based recommendations to be included in a standardised regional MHP. The group found consensus around 42 statements and 8 quality […]

The effect of anemia severity on postoperative morbidity among patients undergoing laparoscopic hysterectomy for benign indications.

This is a very well-designed retrospective study using a large American surgical database (NISQP) reporting the a high incidence of anaemia (19.5%) in patients undergoing elective laparoscopic hysterectomy. The following factors were associated with a high risk of preoperative anaemia: higher body mass index, younger age, Black or African American race, longer operative times, and […]

Impact of a Patient Blood Management monitoring and feedback programme on allogeneic blood transfusions and related costs.

While Patient Blood Management (PBM) is becoming a new standard worldwide with evidence-based and expert consensus guidelines to promote the three PBM pillars, measuring the performance of these efforts remains a challenge. PBM programmes need to measure transfusion reductions and patient-specific outcomes, and report these to drive change. Here is one such impactful report supporting […]

Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant.

The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) cohort study enrolled 3007 atrial fibrillation patients treated with apixaban, dabigatran etexilate or rivaroxaban and scheduled for an elective surgery or procedure. A simple standardised perioperative DOAC therapy interruption and resumption strategy based on DOAC pharmacokinetic properties, procedure-associated bleeding risk and creatinine clearance levels was implemented. The DOAC […]

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