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Preoperative Ticagrelor administration leads to a higher risk of bleeding during and after coronary bypass surgery in a case-matched analysis

Abstract OBJECTIVES To evaluate the effect of Ticagrelor on intra- and postoperative bleeding complications in patients undergoing coronary bypass surgery. METHODS For this study, patients who underwent on-pump or off-pump..

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Antithrombin III for critically ill patients

Abstract Background Critical illness is associated with uncontrolled inflammation and vascular damage which can result in multiple organ failure and death. Antithrombin III (AT III) is an anticoagulant with anti‐inflammatory..

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Different Heparin Contents in Prothrombin Complex Concentrates May Impair Blood Clotting in Outpatients With Ventricular Assist Devices Receiving Phenprocoumon

Abstract Objectives  (PCCs) are used to rapidly reverse  by oral . They differ in the content of , endogenous anticoagulants, and heparin. The authors hypothesized that PCCs’ specific heparin content may compromise the  effect...

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Changes in thrombin generation in children after cardiac surgery and ex-vivo response to blood products and haemostatic agents

Abstract Impaired haemostasis has been reported in children with congenital heart disease undergoing cardiopulmonary bypass. As thrombin generation encompasses all phases of the coagulation process, this analysis might provide the best assessment..

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Tethered Liquid Perfluorocarbon Coating for 72 Hour Heparin-Free Extracorporeal Life Support

Abstract Coagulopathic complications during extracorporeal life support (ECLS) result from two parallel processes: 1) foreign surface contact and shear stress during blood circulation and 2) administration of anticoagulant drugs to..

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Dynamics of appearance and decay of gaseous microemboli during in vitro extracorporeal circulation

Abstract Introduction: Extracorporeal life support (ECLS) patients are at risk for complications caused by gaseous microemboli (GME). GMEs can cause hypoxia, inflammation, coagulation, and end-organ damage. The objective of this..

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Blood cell adhesion to arterial filters analysis by scanning electron microscopy and real-time PCR assay: observational clinical study in cardiac…

Abstract Introduction: Arterial filter is the part of the cardiopulmonary bypass circuit where blood cells are exposed to high mechanical stress and where cellular aggregates may fasten in large quantities...

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Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update

Abstract BACKGROUND:  The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management..

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Utilization of Thromboelastogram and Inflammatory Markers in the Management of Hypercoagulable State in Patients with COVID-19 Requiring ECMO Support

Abstract The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill patients with COVID-19 is evolving. Extracorporeal support independently confers an increased predilection for thrombosis, which can..

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EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients with Suspected or Confirmed COVID-19 Infection: An Expert Consensus from the…

Abstract The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesia (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven..

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A Pilot Study of Antithrombin Replacement Prior to Cardiopulmonary Bypass in Neonates

Abstract Neonates have low levels of antithrombin. Inadequate anticoagulation during cardiopulmonary bypass (CPB) due to low antithrombin activity may result in a poor preservation of the coagulation system during bypass...

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Heparin Resistance Is Common in Patients Undergoing Extracorporeal Membrane Oxygenation but Is Not Associated with Worse Clinical Outcomes

Abstract Extracorporeal membrane oxygenation (ECMO) protocols generally require systemic anticoagulation with heparin to prevent circuit thrombosis. The prevalence, risk factors, and outcomes of heparin resistance in this setting are ill-defined. To better..

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Challenges with heparin-based anticoagulation during cardiopulmonary bypass in children: Impact of low antithrombin activity

Abstract Background  is one of the main natural  inhibitors. It is potentiated by heparin, and may be a key component of heparin response, particularly in infants aged <1 year. We sought to..

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Successful Antithrombin Administration in Andexanet Alfa-Associated Heparin Resistance

Abstract Case Report A 72-year-old man with a tachycardiomyopathy, atrium flutter, and atrial fibrillation underwent an elective radiofrequency ablation procedure. In addition to 5 mg of apixaban twice daily, his..

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Thromboelastometry, Thromboelastography, and Conventional Tests to Assess Anticoagulation During Extracorporeal Support: A Prospective Observational Study

Abstract Optimal anticoagulation monitoring in patients with extracorporeal membrane oxygenation (ECMO) is fundamental to avoid hemorrhagic and thromboembolic complications. Besides conventional coagulation tests, there is growing interest in the use..

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Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients

Abstract Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and..

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An Adjusted Calculation Model Allows for Reduced Protamine Doses without Increasing Blood Loss in Cardiac Surgery

Abstract Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine–heparin ratio used for heparin reversal varies widely among institutions..

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Post-Operative Bleeding Risk Stratification in Cardiac Pulmonary Bypass Patients Using Artificial Neural Network

Abstract The prediction of bleeding risk in cardiopulmonary bypass (CPB) patients plays a vital role in their postoperative management. Therefore, an artificial neural network (ANN) to analyze intra-operative laboratory data..

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Severe antiphospholipid syndrome and cardiac surgery: Perioperative management

Abstract Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac..

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Genetic variation influences the risk of bleeding after cardiac surgery: novel associations and validation of previous findings

Abstract Background Severe post‐operative bleeding in cardiac surgery is associated with increased morbidity and mortality. We hypothesized that variation in genetic susceptibility contributes to post‐operative bleeding in addition to clinical..

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Blood Conservation in Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Abstract Background  support (ECMO) typically requires multiple  and is associated with frequent bleeding complications. Blood transfusions are known to increase morbidity and mortality in critically ill patients, which may extend to..

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Developments in Pediatric Ventricular Assist Device Support

Abstract Mechanical support devices have revolutionized the management of circulatory failure. This has been met by a dramatic increase in ventricular assist device (VAD) utilization in children over the last..

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Reduced re-exploration and blood product transfusion after the introduction of the Papworth haemostasis checklist

Abstract OBJECTIVES Between 2% and 8% of patients return to the theatre for mediastinal bleeding following cardiac surgery. In the majority of patients, a surgical source of bleeding is identified...

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Anticoagulation during ECMO in neonatal and paediatric patients

Abstract  (ECMO) is a form of  (ECLS) which is used frequently in the paediatric and neonatal setting to support either the pulmonary, or both the pulmonary and . Management of ECMO requires..

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Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You

Abstract Pediatric cardiac surgical patients are at particular risk for post-cardiopulmonary bypass hemorrhage. Moreover, both the incidence and volume of  have been associated with increased morbidity in pediatric cardiac patients. Transfusion..

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Three Cases of Anaphylaxis to Protamine: Management of Anticoagulation Reversal

Case 1 A 78-year-old male diabetic patient underwent elective coronary artery bypass grafting (CABG). His insulin therapy had been changed recently to human insulin (Humulin M3; Eli Lilly Italia, Sesto..

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Double-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects of Antithrombin Versus Placebo on the Coagulation System in Infants with Low Antithrombin…

Abstract Objectives To determine whether precardiopulmonary bypass (CPB) normalization of  levels in infants to 100% improves heparin sensitivity and  during CPB and has beneficial effects into the . Design Randomized, double-blinded, placebo-controlled prospective..

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A comparison of the new ROTEM®sigma with its predecessor, the ROTEMdelta

Summary Thromboelastometry point‐of‐care coagulation testing facilitates optimised management of bleeding. Previous thromboelastometry systems required the blood sample and liquid reagents to be pipetted in several manual steps by trained personnel...

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Evaluation of Systemic Heparin Versus Bivalirudin in Adult Patients Supported by Extracorporeal Membrane Oxygenation

Abstract Systemic anticoagulation is a standard of care in adult patients supported by extracorporeal membrane oxygenation (ECMO) to prevent circuit thrombosis and subsequent thromboembolic events. Unfractionated heparin has long been..

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Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: Rapid onset and fast recovery

Abstract Background Bleeding contributes to the high mortality of venovenous  membrane oxygenation (vvECMO). The development of acquired von Willebrand syndrome (AVWS) has been identified as relevant pathology during ECMO. This study..

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