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Anesthesia & Analgesia, Vol 82, 13-21, Copyright © 1996 by International Anesthesia Research Society
Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients
GJ Despotis, KS Filos, TN Zoys, CW Hogue Jr, E Spitznagel and DG Lappas
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
The purpose of this study was to prospectively evaluate whether heparin and
protamine doses administered using a standardized protocol based on body
weight and activated clotting time values are associated with either
transfusion of hemostatic blood products (HBPs) or excessive postoperative
bleeding. Analysis using 10 multiple logistic or linear regression models
in 487 cardiac surgical patients included perioperative variables that may
have an association with either transfusion of HBP and/or excessive
postoperative chest tube drainage (CTD). Prolonged duration of
cardiopulmonary bypass (CPB), lower pre- CPB heparin dose, lower core body
temperature in the intensive care unit, combined procedures, older age,
repeat procedures, a larger volume of salvaged red cells reinfused
intraoperatively and abnormal laboratory coagulation results (prothrombin
time, activated partial thromboplastin time, and platelet count) after CPB
were associated with both transfusion of HBP and increased CTD. Female
gender, lower total heparin dose, preoperative aspirin use and the number
of HBPs administered intraoperatively were associated only with increased
CTD, whereas a larger total protamine dose was associated only with
perioperative transfusion of HBPs. Preoperative use of warfarin or heparin
was not associated with excessive blood loss of perioperative transfusion
of HBPs. In contrast to previous studies using bovine heparin, data from
the present study do not support the use of reduced doses of porcine
heparin during CPB.
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