Act values after neutralization lower than pre-heparinization act leads to lower operative times, bleeding, and post-operative transfusions in cabg pa

Abstract Objective: To evaluate if lower activated coagulation time (ACT) value after neutralization than preoperative ACT value was effective in reducing bleeding, operative times, and post-operative transfusions in patients underwent coronary artery bypass grafting (CABG). Methods: Retrospective selection of 398 patients from January 2014 to May 2017. Patients were divided into 2 groups according to final ACT after neutralization: A - final ACT lower than preoperative ACT; and B - final ACT higher than or equal to preoperative ACT. Hemostatic time, intraoperative blood loss, ACT after final neutralization, mediastinal blood loss, and transfusion requirements were observed. Results: The hourly blood loss in the Group A was generally lower than in the Group B at first 3 hours, which has significant difference (P<0.05). However, there was no difference after 3 hours between the two groups. Operative time, intraoperative blood loss, mediastinal blood loss, transfusion requirements, and drainage in the first postoperative 12 hours in the Group A were lower than in Group B, which has significant difference (P<0.05). Conclusion: As a result, final ACT values lower than pre-heparinization ACT values are safe and lead to lower operative times, bleeding, and post-operative transfusions.

Manejo del sangrado periopeatorio en cirugía y trasplante hepático basado en objetivos / Management of perioperative bleeding in surgery and liver transplantation based on objectives

Los “Point of Care” test (POC) como la Tromboelastografía, tienen como objetivo realizar de forma simple y rápida el diagnóstico del estado de la coagulación y permitir intervenciones profilácticas y terapéuticas rápidas y adaptadas al contexto clínico. La Tromboelastografía, forma parte integral de los programas que plantean un abordaje multidisciplinario para la aplicación efectiva de medidas basadas en la evidencia, tendientes a optimizar la volemia del paciente, minimizar el sangrado y reducir significativamente o incluso suprimir la transfusión de sangre alogénica.Se propone un Protocolo, basado en una revisión no sistemática de la literatura, que establece una guía de referencia para la profilaxis y el tratamiento de las alteraciones de la coagulación sanguínea durante perioperatorio en los pacientes sometidos a Cirugía Hepática y Trasplante Hepático.