Update in Perioperative Blood Management
Title: Update in Factor Concentrate Use for Perioperative Coagulation Management
Transfusion Medicine is at an important junction for the re-evaluation of the current hemostatic management of the bleeding patient. In North America and many other countries, the use of non-pathogen reduced blood components is the routine (plasma, platelets, and cryoprecipitate). In contrast, in most European countries, components have been superseded by pooled, pathogen-reduced fractionated (fibrinogen concentrates, prothrombin complex concentrates) and non-fractionated products (solvent detergent treated pooled plasma). This lecture will review the scientific trial evidence to support/refute the transition from classic components to pathogen-reduced coagulation products. Pathogen-reduced fractionated products have the potential to reduce the risk of emerging pathogen transmission, shorten the time to administration, allow for near-patient storage, allow for administration in remote locations and during land and air transport, and to reduce transfusion reactions (due to pooling reducing the risk of transfusion-related acute lung injury and allergic reactions and smaller volumes reducing the risk of transfusion-associated circulatory overload).
– Upon completion, participant will be able to describe the difference between standard blood components and pathogen-reduced hemostatic products
– Upon completion, participant will be able to state the currently available pathogen-inactivated blood products available in Canada.
– Upon completion, participant will be able to cite the current clinical trial evidence comparing hemorrhage management with standard components and with pathogen-reduced hemostatic products.
– Upon completion, participant will be able to state the pending clinical trials that will further clarify the pros and cons of the two different blood resuscitation strategies.
– Upon completion, participants will be able to confidently dose all the different hemostatic agents.
A summary of results from translational animal studies and clinical trials which will help to define thresholds of anemia induced tissue hypoxia; the hemoglobin concentrations at which organ specific tissue hypoxia can be demonstrated; clinical evidence that tissue hypoxia contributes to organ dysfunction and injury an finally, an assessment of the value of restrictive vs. liberal transfusion thresholds in different patient populations.
– To describe the adaptive cardiovascular mechanism by which mammals adapt to acute blood loss and the evidence which demonstrates that anemia induced tissue hypoxia occurs.
– To describe and evaluate the translational and clinical studies which provide evidence that anemia-induced tissue hypoxia may result in organ injury and increased mortality.
– To evaluate the results from completed randomized controlled trials and assess sub-populations of patients that may be at risk of adverse outcomes when a restrictive transfusion strategy is utilized.
– To propose new approaches to improving outcomes in patients experiencing acute and chronic anemia in the perioperative period. Speaker: Greg Hare
To present some of the current evidence for thromboelastometric testing in the perioperative setting AND share the Montreal Heart Institute’s experience with implementation of this technology.
1. Describe how viscoelastic testing works.
2. Identify the advantages and limitations of viscoelastic testing.
3. Recognize the potential value of the use of viscoelastic testing in the perioperative setting.