Impact of Additional Administration of von Willebrand Factor Concentrates to Thrombocyte Transfusion in Perioperative Bleeding in Cardiac Surgery.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-07-11 eCollection Date: 2024-02-01 DOI:10.1159/000530810

Katrin Ledergerber, Alexa Hollinger, Sibylle Zimmermann, Atanas Todorov, Maren Trutmann, Laura Gallachi, Lena Anna Gschwandtner, Lisa Andrea Ryser, Caroline Eva Gebhard, Daniel Bolliger, Andreas Buser, Dimitrios Athanasios Tsakiris, Martin Siegemund

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引用次数: 0

Abstract

Background: Von Willebrand factor (vWF) is an important part of blood coagulation since it binds platelets to each other and to endothelial cells. In traumatic and surgical haemorrhage, both blood cells and plasmatic factors are consumed, leading to consumption coagulopathy and fluid resuscitation. This often results in large amounts of crystalloids and blood products being infused. Additional administration of vWF complex and platelets might mitigate this problem. We hypothesize that administration of vWF concentrate additionally to platelet concentrates reduces blood loss and the amount of blood products (platelets, red blood cells [RBC], fresh frozen plasma [FFP]) administered.

Methods: We conducted a monocentric 6-year retrospective data analysis of cardiac surgery patients. Included were all patients receiving platelet concentrates within 48 h postoperatively. Patients who additionally received vWF concentrates were allocated to the intervention group and all others to the control group. Groups were compared in mixed regression models correcting for known confounders, based on nearest neighbour propensity score matching. Primary endpoints were loss of blood (day one and two) and amount of needed blood products on day one and two (platelets, RBC, FFP). Secondary endpoints were intensive care unit (ICU) and in-hospital length of stay, ICU and in-hospital mortality, and absolute difference of platelet counts before and after treatment.

Results: Of 497 patients analysed, 168 (34%) received vWF concentrates. 121 patients in both groups were considered for nearest neighbour matching. Patients receiving additional vWF were more likely to receive more blood products (RBC, FFP, platelets) in the first 24 h after surgery and had around 200 mL more blood loss at the same time.

Conclusion: In this retrospective analysis, no benefit in additional administration of vWF to platelet concentrates on perioperative blood loss, transfusion requirement (platelets, RBC, FFP), length of stay, and mortality could be found. These findings should be verified in a prospective randomized controlled clinical trial (www.clinicaltrials.gov identifier NCT04555785).

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心脏外科手术围手术期出血时额外使用血管性血友病因子浓缩物对血小板输注的影响

背景：血管性血友病因子（vWF）是血液凝固的重要组成部分，因为它将血小板相互结合并与内皮细胞结合。在创伤和手术出血中，血细胞和血浆因子都被消耗掉，导致消耗性凝血障碍和液体复苏。这通常会导致大量的晶体和血液制品被注入。vWF复合物和血小板的额外给药可能会缓解这个问题。我们假设在血小板浓缩物的基础上再给予vWF浓缩物可以减少血液损失和血液制品（血小板、红细胞[RCB]、新鲜冷冻血浆[FFP]）的施用量。方法：我们对心脏手术患者进行了为期6年的单中心回顾性数据分析。包括术后48小时内接受浓缩血小板治疗的所有患者。额外接受vWF浓缩物的患者被分配到干预组，所有其他患者被分配给对照组。基于最近邻倾向得分匹配，在校正已知混杂因素的混合回归模型中对各组进行比较。主要终点是血液损失（第一天和第二天）和第一天和两天所需血液制品的量（血小板、红细胞、FFP）。次要终点是重症监护室（ICU）和住院时间、ICU和住院死亡率以及治疗前后血小板计数的绝对差异。结果：在分析的497名患者中，168名（34%）接受了vWF浓缩液治疗。两组中的121名患者被考虑进行最近邻匹配。接受额外vWF的患者更有可能在手术后的前24小时内接受更多的血液制品（RBC、FFP、血小板），同时失血量增加约200毫升。结论：在这项回顾性分析中，在浓缩血小板的基础上额外给予vWF对围手术期失血、输血需求（血小板、红细胞、FFP）、住院时间和死亡率没有任何益处。这些发现应在前瞻性随机对照临床试验中进行验证（www.clinicaltrials.gov identifier NCT04555785）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.