SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study.

Surgical patients may be at high risk of venous thromboembolism (VTE). SARS‐CoV‐2 infection has been shown to increase this risk. In this huge international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020, the authors included 123,791 patients from all surgical specialities in 1630 hospitals and 115 countries. The primary outcome measure […]

Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial.

Current approaches to trauma resuscitation focus on the timely control of bleeding and correction of trauma-induced coagulopathy using the administration of haemostatic therapy. Over the past decade, targeted and individualized strategies to identify and correct coagulopathy have been implemented. Conventional coagulation tests have been incorporated into standardized transfusion algorithms but suffer from slow turn-around times. […]

Routine venous thromboembolism prophylaxis may be inadequate in the hypercoagulable state of severe coronavirus disease 2019.

This observationnal study has included 240 consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection  admitted to one of three hospitals. One-hundred nine critically ill COVID 19 patients admitted to the ICU were included in the analysis.  Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two […]

Fibrinogen concentrate to cardiac surgery patients with ongoing bleeding does not increase the risk of thromboembolic complications or death.

In this retrospective, observational study, Waldén et al. describe the occurrence of thromboembolic events and mortality in cardiac surgery patients, depending on whether the patient had received fibrinogen supplementation. The study comprises 5,408 patients, of which 564 (10.4%) received fibrinogen during cardiac surgery. Patients receiving fibrinogen had lower preoperative levels of fibrinogen and platelet count, […]

Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial.

In this multicentre, parallel-group, open-label, randomised trial, the authors compared the efficacy and safety of rivaroxaban versus standard anticoagulants in children 0-17 years with venous thromboembolism. Across 107 paediatric hospitals in 28 countries, children with documented acute venous thromboembolism (VTE) who had started heparin were assigned (2:1) to weight-adjusted rivaroxaban or standard anticoagulants (heparin or […]

Preterm neonates benefit from low prophylactic platelet transfusion threshold despite varying risk of bleeding or death.

The Platelets for Neonatal Thrombocytopenia (PlaNeT-2) trial, a multicentre randomised clinical trial, found an unexpected overall benefit of a prophylactic platelet transfusion threshold of 25 x 10^9/L compared to 50 x 10^9/L for major bleeding and/or mortality within 28 days of randomization in preterm neonates (7% absolute risk reduction). To assess if there was heterogeneity of treatment effect and […]

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 […]

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 […]

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, […]

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 […]