Reducing Blood Transfusion in Aortic Surgery: A Novel Approach.

Abstract

BACKGROUND\nWe introduced a new algorithm utilising patients own platelet rich plasma and factor concentrates to better manage coagulopathy in aortic surgery under circulatory arrest. This study compares the outcomes of the patients treated with a new algorithm to that of the patients managed with our traditional approach.\n\n\nMETHODS\nThe data of 247 consecutive patients who had aortic surgery was analysed. 158 patients (Group 1) who were managed with our usual algorithm were compared with 89 patients (Group 2) who were treated with the novel algorithm consisting of utilisation of patients own platelet rich plasma, fibrinogen and prothrombin cell concentrates. Differences in transfusion, and the ICU stay were analysed. Univariate and Multivariable robust regression analysis were performed.\n\n\nRESULTS\nIn comparison to Group 1, the patients in Group 2 had significantly reduced need for transfusion of for red cells ( (7.9 ± 8.6 vs 3.5 ± 3.8, p<0.001). Postoperative intubation time was reduced from a mean of 42 hours to a mean of 12 hours ( p<0.001).. The length to medical discharge from the ICU reduced from a mean of 7 days to a mean of 5 days (p<0.001). favouring the new algorithm. After adjustment for demographics and co-morbidities, the novel algorithm remained significantly associated with a reduction in units of red blood cells transfused (robust parameter estimate =-1.14; p=0.027) and blood products transfused (robust parameter estimate = -5.11; p<0.001) CONCLUSIONS: Using autologous plasma and factor concentrates to reverse coagulopathy in aortic surgery significantly reduces blood product transfusion.