心脏手术中凝血因子浓缩物的使用和输血：对遗传性和获得性出血性疾病成人的回顾性队列研究。

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-10-18 DOI:10.1016/j.bja.2024.07.041

Kenichi A. Tanaka , Hisako Okada , Amir L. Butt , Kofi B. Vandyck , Srikiran Ramarapu , Cheryl L. Maier , Roman M. Sniecinski , Kenneth E. Stewart

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引用次数: 0

摘要

背景：心脏手术具有围术期出血和异体输血的重大风险，尤其是对出血性疾病患者而言。越来越频繁地使用凝血因子浓缩物可能会影响出血风险、血栓栓塞事件和成本。我们描述了患有遗传性和获得性出血性疾病的心脏手术患者使用凝血因子浓缩物和异体血制品的情况，以评估相关结果，包括围手术期出血、血栓栓塞和住院费用。结果与遗传性出血性疾病或无出血性疾病患者相比，获得性出血性疾病患者需要更广泛地使用凝血因子浓缩物和血液制品。后天性出血性疾病组患者使用凝血因子浓缩物的比例最高，其中 24% 的患者使用因子 VIIa，11.7% 的患者使用凝血酶原复合物浓缩物。该组的并发症发生率也明显较高，其中大出血发生率为 15.8%，血栓栓塞事件发生率为 19.2%。后天性出血性疾病组的重症监护和住院时间更长，死亡率也最高（19.2%）。遗传性出血性疾病组围手术期更多地使用因子 VIII 和因子 IX 替代品导致药房成本增加，但对血库费用没有显著影响。改善围术期止血管理和血栓预防策略对于优化患者预后和降低费用至关重要。

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Use of coagulation factor concentrates and blood transfusion in cardiac surgery: a retrospective cohort study of adults with hereditary and acquired bleeding disorders

Background

Cardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients with hereditary and acquired bleeding disorders to assess pertinent outcomes, including perioperative haemorrhage, thromboembolism, and hospital costs.

Methods

We conducted a retrospective cohort study using the Premier Health Database, including adult cardiac surgical patients diagnosed with hereditary or acquired bleeding disorders compared with those without bleeding disorders.

Results

Patients with acquired bleeding disorders required more extensive use of coagulation factor concentrates and blood products compared with those with hereditary bleeding disorders or without bleeding disorders. The highest exposures to coagulation factor concentrates were found in the acquired bleeding disorders group, with 24% receiving factor VIIa and 11.7% receiving prothrombin complex concentrate. This group also experienced significantly higher rates of complications, including a 15.8% rate of haemorrhage and a 19.2% rate of thromboembolic events. The acquired bleeding disorders group had longer intensive care and hospital stays, and the highest mortality rate (19.2%). The increased use of perioperative replacement of factor VIII and factor IX in the hereditary bleeding disorders group led to increased pharmacy costs but did not significantly impact blood bank charges.

Conclusions

Acquired bleeding disorders in cardiac surgery patients are associated with increased use of haemostatic interventions, postoperative complications, and increased healthcare costs. Improved management of perioperative haemostasis and thromboprophylaxis strategies are essential for optimising patient outcomes and reducing expenses.

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.