GOAL-DIRECTED HEMOSTATIC THERAPY IN CARDIAC SURGERY — CHANGES IN TRANSFUSION STRATEGY?
Keywords:
transfusion therapy, cardiac surgery, antiplatelet therapy, donor platelet concentrate, platelet aggregation, thrombin generation testAbstract
The aim of the study were changes in support of transfusion strategies justification in patients with preserved antiplatelet basic therapy, and efficacy evaluation in this group of safety and clinical feasibility goal-oriented correction of hemostasis. Materials and methods. We studied the change in strategy transfusion therapy during cardiac surgery in the preoperative antiplatelet therapy variants and extension of diagnostic tests of hemostasis. Was provided a retrospective analysis of transfusion service establishments medical documentation and 1356 histories of patients with coronary artery disease undergoing coronary artery bypass grafting with cardiopulmonary bypass. In addition to standard coagulation tests were determined values of platelet aggregation test, thrombin generation test, the peak concentration (peak thrombin, nmol / L) and lagtime (sec), and the overall shape of the lowfrequency pyezoelastography. Results. It has been established that the definition of additional parameters of coagulation hemostasis allows significantly reduce the total amount and change the structure of transfusion support. Demonstrated the safety of complete antiplatelet therapy in the preoperative preparation for cardiac surgery at the goal-directed correction of hemostasis in the perioperative period. Conclusion. Changes in the strategy of transfusion therapy during cardiac surgical procedures as well as hemostasis diagnostic tests have been studied and developed in different options of preoperative management of patients under antiplatelet therapy. The determination of additional coagulation parameters of hemostasis allows reducing the total number and changing the structure of transfusion requirements. Continuation of antiplatelet therapy in the preoperative period proved to be safe for goal-directed hemostatic therapy in the perioperative period.
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