RSS-Feed abonnieren
DOI: 10.1055/s-0028-1092873
Prohemostatic Agents to Prevent Perioperative Blood Loss
Publikationsverlauf
Publikationsdatum:
27. Oktober 2008 (online)
![](https://www.thieme-connect.de/media/sth/200805/lookinside/thumbnails/10.1055-s-0028-1092873-1.jpg)
ABSTRACT
Surgical patients represent a unique group of patients where therapeutic approaches can be preemptively administered. Pharmacologic strategies to prevent or decrease perioperative bleeding function to attenuate inflammatory responses, reduce hemostatic activation, or provide prohemostatic effects to reduce bleeding and the need for allogeneic transfusions. This article will discuss pharmacologic prohemostatic agents (antifibrinolytics, protamine, desmopressin, fibrinogen, purified protein concentrates, recombinant factor VIIa).
KEYWORDS
Aprotinin - aintifibrinolytics - bleeding - desmopressin - fibrinogen - factor VIIa - recombinant - transfusion - surgery
REFERENCES
- 1 Mannucci P M, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007; 356 2301-2311
- 2 Spiess B D, Royston D, Levy J H et al.. Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes. Transfusion. 2004; 44 1143-1148
- 3 Spiess B D. Risks of transfusion: outcome focus. Transfusion. 2004; 44 4S-14S
- 4 Spiess B D. Transfusion of blood products affects outcome in cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004; 8 267-281
- 5 Levy J H. Massive transfusion coagulopathy. Semin Hematol. 2006; 43 S59-S63
- 6 Karkouti K, Wijeysundera D N, Yau T M et al.. The independent association of massive blood loss with mortality in cardiac surgery. Transfusion. 2004; 44 1453-1462
- 7 Despotis G J, Zhang L, Lublin D M. Transfusion risks and transfusion-related pro-inflammatory responses. Hematol Oncol Clin North Am. 2007; 21 147-161
- 8 Levy J H, Tanaka K A, Steiner M E. Evaluation and management of bleeding during cardiac surgery. Curr Hematol Rep. 2005; 4 368-372
- 9 Levy J H. Overview of clinical efficacy and safety of pharmacologic strategies for blood conservation. Am J Health Syst Pharm. 2005; 62 S15-S19
- 10 Royston D, Chhatwani A. Safety aspects of aprotinin therapy in cardiac surgery patients. Expert Opin Drug Saf. 2006; 5 539-552
- 11 Levi M, Cromheecke M E, de Jonge E et al.. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet. 1999; 354 1940-1947
- 12 Henry D A, Moxey A J, Carless P A et al.. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2001; CD001886
- 13 Sedrakyan A, Treasure T, Elefteriades J A. Effect of aprotinin on clinical outcomes in coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized clinical trials. J Thorac Cardiovasc Surg. 2004; 128 442-448
- 14 Mangano D T, Tudor I C, Dietzel C. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006; 354 353-365
- 15 Mangano D T, Miao Y, Vuylsteke A et al.. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery. JAMA. 2007; 297 471-479
- 16 Fergusson D A, Hébert P C, Mazer C D et al.. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008; 358 2319-2331
- 17 Levi M M, Vink R, de Jonge E. Management of bleeding disorders by prohemostatic therapy. Int J Hematol. 2002; 76(Suppl 2) 139-144
- 18 Kikura M, Levy J H, Tanaka K A, Ramsay J G. A double-blind, placebo-controlled trial of epsilon-aminocaproic acid for reducing blood loss in coronary artery bypass grafting surgery. J Am Coll Surg. 2006; 202 216-222
- 19 Zufferey P, Merquiol F, Laporte S et al.. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?. Anesthesiology. 2006; 105 1034-1046
- 20 Levy J H, Adkinson N F. Anaphylaxis during cardiac surgery: implications for clinicans. Anesth Analg. 2008; 106 392-403
- 21 Levy J H, Zaidan J R, Faraj B. Prospective evaluation of risk of protamine reactions in patients with NPH insulin-dependent diabetes. Anesth Analg. 1986; 65 739-742
- 22 Levy J H, Schwieger I M, Zaidan J R, Faraj B A, Weintraub W S. Evaluation of patients at risk for protamine reactions. J Thorac Cardiovasc Surg. 1989; 98 200-204
- 23 Mannucci P M. Treatment of von Willebrand's disease. N Engl J Med. 2004; 351 683-694
- 24 Mannucci P M. Hemostatic drugs. N Engl J Med. 1998; 339 245-253
- 25 Mannucci P M. Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood. 1997; 90 2515-2521
- 26 Federici A B, Mannucci P M. Management of inherited von Willebrand disease in 2007. Ann Med. 2007; 39 346-358
- 27 Frankville D D, Harper G B, Lake C L, Johns R A. Hemodynamic consequences of desmopressin administration after cardiopulmonary bypass. Anesthesiology. 1991; 74 988-996
- 28 Rocha E, Llorens R, Paramo J A, Arcas R, Cuesta B, Trenor A M. Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass?. Circulation. 1988; 77 1319-1323
- 29 Salzman E W, Weinstein M J, Reilly D, Ware J A. Adventures in hemostasis. Desmopressin in cardiac surgery. Arch Surg. 1993; 128 212-217
- 30 Salzman E W, Weinstein M J, Weintraub R M et al.. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double-blind randomized trial. N Engl J Med. 1986; 314 1402-1406
- 31 Weinstein M, Ware J A, Troll J, Salzman E. Changes in von Willebrand factor during cardiac surgery: effect of desmopressin acetate. Blood. 1988; 71 1648-1655
- 32 de Prost D, Barbier-Boehm G, Hazebroucq J et al.. Desmopressin has no beneficial effect on excessive postoperative bleeding or blood product requirements associated with cardiopulmonary bypass. Thromb Haemost. 1992; 68 106-110
- 33 Mannucci P M, Carlsson S, Harris A S. Desmopressin, surgery and thrombosis. Thromb Haemost. 1994; 71 154-155
- 34 Nielsen V G, Levy J H. Fibrinogen and bleeding: old molecule–new ideas. Anesth Analg. 2007; 105 902-903
- 35 Blome M, Isgro F, Kiessling A H et al.. Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery. Thromb Haemost. 2005; 93 1101-1107
- 36 Charbit B, Mandelbrot L, Samain E et al.. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost. 2007; 5 266-273
- 37 Steiner M E, Key N S, Levy J H. Activated recombinant factor VII in cardiac surgery. Curr Opin Anaesthesiol. 2005; 18 89-92
- 38 Roberts H R, Monroe D M, White G C. The use of recombinant factor VIIa in the treatment of bleeding disorders. Blood. 2004; 104 3858-3864
- 39 ten Cate H, Bauer K A, Levi M et al.. The activation of factor X and prothrombin by recombinant factor VIIa in vivo is mediated by tissue factor. J Clin Invest. 1993; 92 1207-1212
- 40 Butenas S, Brummel K E, Branda R F, Paradis S G, Mann K G. Mechanism of factor VIIa-dependent coagulation in hemophilia blood. Blood. 2002; 99 923-930
- 41 Levy J H, Fingerhut A, Brott T, Langbakke I H, Erhardtsen E, Porte R J. Recombinant factor VIIa in patients with coagulopathy secondary to anticoagulant therapy, cirrhosis, or severe traumatic injury: review of safety profile. Transfusion. 2006; 46 919-933
- 42 O'Connell K A, Wood J J, Wise R P, Lozier J N, Braun M M. Thromboembolic adverse events after use of recombinant human coagulation factor VIIa. JAMA. 2006; 295 293-298
- 43 Ozgonenel B, O'Malley B, Krishen P, Eisenbrey A B. Warfarin reversal emerging as the major indication for fresh frozen plasma use at a tertiary care hospital. Am J Hematol. 2007; 82 1091-1094
- 44 Dager W E, King J H, Regalia R C et al.. Reversal of elevated international normalized ratios and bleeding with low-dose recombinant activated factor VII in patients receiving warfarin. Pharmacotherapy. 2006; 26 1091-1098
- 45 Lankiewicz M W, Hays J, Friedman K D, Tinkoff G, Blatt P M. Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost. 2006; 4 967-970
- 46 Kessler C M. Urgent reversal of warfarin with prothrombin complex concentrate: where are the evidence-based data?. J Thromb Haemost. 2006; 4 963-966
- 47 Dickneite G. Prothrombin complex concentrate versus recombinant factor VIIa for reversal of coumarin anticoagulation. Thromb Res. 2007; 119 643-651
- 48 Taketomi T, Szlam F, Levy J H, Tanaka K A. Warfarin reversal with prothrombin complex concentrate confers better antifibrinolytic activity compared with recombinant activated factor VII. Blood Coagul Fibrinolysis. 2008; 19 106-108
Jerrold H LevyM.D. F.A.H.A.
Emory University Hospital, 1364 Clifton Road
NE, Atlanta, GA 30322
eMail: jlevy01@emory.edu