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1.
Med. intensiva (Madr., Ed. impr.) ; 39(9): 552-562, dic. 2015.
Article in Spanish | IBECS | ID: ibc-145029

ABSTRACT

Estos últimos años han aparecido alertas de seguridad, no siempre bien sustentadas, que cuestionan el uso de algunas alternativas farmacológicas a la transfusión de sangre alogénica y/o lo restringen en indicaciones establecidas. Asistimos también a la preconización de otras alternativas, incluyendo productos hemáticos y fármacos antifibrinolíticos, sin que haya una base científica sólida que lo justifique. Por iniciativa del Grupo de Estudios Multidisciplinares sobre Autotransfusión y del Anemia Working Group España se reunió a un panel multidisciplinar de 23 expertos del área de cuidados de la salud en un foro de debate para: 1) analizar las diferentes alertas de seguridad en torno a ciertas alternativas a la transfusión; 2) estudiar los antecedentes que las han propiciado, la evidencia que las sustentan y las consecuencias que conllevan para la práctica clínica, y 3) emitir una valoración argumentada de la seguridad de cada alternativa a la transfusión cuestionada, según el uso clínico de la misma. Los integrantes del foro mantuvieron contactos por vía telemática y una reunión presencial en la que presentaron y discutieron las conclusiones sobre cada uno de los elementos examinados. Se elaboró un primer documento que fue sometido a 4 rondas de revisión y actualización hasta alcanzar un consenso, unánime en la mayoría de los casos. Presentamos la versión final del documento, aprobada por todos los miembros del panel, esperando sea de utilidad para nuestros colegas


In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues


Subject(s)
Humans , Blood Transfusion, Autologous/methods , Blood Transfusion/methods , Postoperative Hemorrhage/therapy , Critical Care/methods , Intensive Care Units/organization & administration , Erythropoiesis/physiology , Factor VIII/pharmacokinetics , Colloids/pharmacokinetics , Patient Safety
2.
Med Intensiva ; 39(9): 552-62, 2015 Dec.
Article in English, Spanish | MEDLINE | ID: mdl-26183121

ABSTRACT

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.


Subject(s)
Anemia/therapy , Critical Illness/therapy , Hemorrhage/therapy , Anemia/drug therapy , Antifibrinolytic Agents/adverse effects , Antifibrinolytic Agents/therapeutic use , Aprotinin/adverse effects , Aprotinin/therapeutic use , Blood Coagulation Factors/adverse effects , Blood Coagulation Factors/therapeutic use , Blood Transfusion/standards , Clinical Trials as Topic , Crystalloid Solutions , Erythropoietin/adverse effects , Erythropoietin/therapeutic use , Hematinics/adverse effects , Hematinics/therapeutic use , Humans , Hydroxyethyl Starch Derivatives/adverse effects , Hydroxyethyl Starch Derivatives/therapeutic use , Iron/adverse effects , Iron/therapeutic use , Isotonic Solutions/adverse effects , Isotonic Solutions/therapeutic use , Meta-Analysis as Topic , Observational Studies as Topic , Plasma Substitutes/adverse effects , Plasma Substitutes/therapeutic use , Recombinant Proteins/adverse effects , Recombinant Proteins/therapeutic use , Tranexamic Acid/adverse effects , Tranexamic Acid/therapeutic use , Transfusion Reaction
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