Optimal Perioperative Coagulation Management
Dr Peter McCall
There is an ever increasing body of evidence that postulates the association and probable casual link between the transfusion of red cells and haemostatic components (Fresh Frozen Plasma FFP, Cryoprecipitate and platelets) and adverse events. Two thirds of blood product usage is in the perioperative period. It is estimated that anaesthetists and intensivists are responsible for at least three quarters of perioperative transfusions. It is sobering then to read the results of an audit into FFP usage in Victorian Hospitals. 25% of usage was deemed unnecessary. Clearly as major participants in perioperative transfusion, anaesthetists and intensivists should be able to make rational decisions and become leaders in this area of clinical medicine.
Transfusion practice needs to be individualized to each clinical scenario. “Cook-Book” approaches are to be discouraged. This presentation aims to equip practitioners with the basic information to be able to make rational decisions.
Whilst an in depth understanding of current concepts of the mechanisms of haemostasis are not necessary, the excellent review by Harold Roberts and Dougald Monroe included in the reading list is recommended.
This presentation will include a review of the basic sciences including the effects of hemodilution, hypothermia and acidosis on coagulation. The contentious issue of surgical versus haematologic bleeding will be addressed. The clinical applicability and limitation of laboratory and point of care testing such as thromboelastoqraphy will be reviewed. Patient factors, clinical scenarios and variability of available blood banking resources will be discussed.
New guidelines for warfarin reversal will be presented. The role for pharmacology agent such as aprotinin, tranexamic and rVIIa will be addressed.
With an understanding of relevant issues, clinicians can form a transfusion strategy based on a calculation of “acceptable blood loss”. A logical approach to component transfusion will result.Sound clinical assessment and judgement is required in transfusion medicine. The tendency to … transfusion will improve patient outcome needs to change. Prophylactic administration of haemostatic factor is rarely indicated. The tendency to over transform, believing it will do no harm and possibly improve outcome need to change.
Time of Presentation
1530
