Heparin titration protocol with tranexamic acid in cardiac surgery: a pilot study

Year 2021, , 282 - 288, 31.12.2021

Başak Soran Türkcan , Ertekin Utku Ünal , Erman Kiriş Bahadır Aytekin , Bekir Akkaya Z.aslı Demir , Aslıhan Aykut Ayşen Aksöyek Levent Bırıncıoğlu

https://doi.org/10.30565/medalanya.956769

Abstract

Aim: Postoperative bleeding related to cardiac surgery is a clinically important condition. Consequently, re-exploration and increased blood utilization lead to adverse outcomes. The aim of this pilot study was to assess the effect of a newly adapted blood conservation strategy, including heparin titration protocol along with antifibrinolytics, regarding to mediastinal bleeding, re-exploration for bleeding and blood and blood products utilization.

Methods: This study included 100 patients undergoing cardiac surgery with higher risk for bleeding, such as mitral valve replacement, aortic valve replacement, ascending / arcus aortic surgery, between January 2015 and August 2016. The study group consisted of consecutive patients who underwent new protocol (heparin titration protocol + tranexamic acid). The control group consisted of patients who were administered standard dose heparin(4 mg/kg). Fifty patients in each group (with the new protocol and the standard protocol) were compared by means of amount of heparin applied, blood utilization, mediastinal drainage and rate of re-exploration.

Results: Twenty-eight of the 50 study group patients (56%) received a red blood cell (RBC) transfusion for the first 24 hours. RBC transfusion ≥ 3 units was lower in the study group (34% vs 54%; p=0.044). Moreover, mediastinal drainage and blood utilization was found to be lower at the study group, however re-exploration rates remained similar.

Conclusion: Based on our study results, the suggested heparin titration protocol seemed to be beneficial for reducing postoperative bleeding and blood product usage. We consider that blood utilization protocols like our heparin titration protocol should be established to reduce the need for blood transfusion in cardiac surgery.

Keywords

Cardiac Surgery, heparin titration, tranexamic acid, blood transfusion,, drainage,

Kalp Cerrahisinde Traneksamik Asit ile Beraber Heparin Titrasyon Protokolü Kullanımına Yönelik Bir Pilot Çalışma

Abstract

Amaç: Kalp cerrahisi ile ilişkili postoperatif kanama klinik olarak önemli bir durumdur. Sonuç olarak, reeksplorasyon ve artan kan kullanımı olumsuz sonuçlara yol açar. Bu pilot çalışmanın amacı, mediastinal kanama, kanama sebepli reeksplorasyon ve kan-kan ürünü kullanımına ilişkin antifibrinolitikler ile birlikte heparin titrasyon protokolünü içeren yeni uyarlanmış bir kan koruma stratejisinin etkisini değerlendirmektir.

Yöntemler: Bu çalışmaya Ocak 2015 ile Ağustos 2016 tarihleri arasında mitral kapak replasmanı, aort kapak replasmanı, asendan/arkus aort cerrahisi gibi kanama riski daha yüksek kalp cerrahisi geçiren 100 hasta dahil edilmiştir. Çalışma grubu yeni protokol uygulanan ardışık hastalardan oluşmaktadır.(heparin titrasyon protokolü+traneksamik asit) Kontrol grubu ise standart doz heparin (4 mg/kg) uygulanan hastalardan oluşmaktadır.Her gruptaki 50 hasta (yeni protokol ve standart protokol) uygulanan heparin miktarı, kan-kan ürünü kullanımı, mediastinal drenaj ve reeksplorasyon açısından karşılaştırıldı.

Bulgular: Çalışma grubundaki 50 hastanın 28’i (%56) ilk 24 saat boyunca kırmızı kan hücresi (RBC) transfüzyonu aldı. 3 üniteden fazla RBC transfüzyonu alan hasta sayısı çalışma grubunda daha düşüktü. (%34’e karşı %54; p=0.044). Ayrıca reeksplorasyon oranları benzer olarak bulundu.

Sonuç: Sonuç olarak, çalışma sonuçlarımıza göre önerilen heparin titrasyon protokolünün postoperative kanama ve kan ürünü kullanımını azaltmada faydalı olduğu görülmektedir. Kalp cerrahisinde kan transfüzyonu ihtiyacını azaltmak için heparin titrasyon protokolü gibi kan kullanım protokollerinin oluşturulması gerektiğini düşünüyoruz. 

Keywords

kalp cerrahisi, traneksamik asit, heparin titrasyonu, drenaj,, kan transfüzyonu,

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