[Survey of perioperative hemostasis and transfusion management in cardiac surgery: how do anesthesiologists practice?]. / Encuesta de hemostasia y transfusión perioperatoria en cirugía cardiaca: cómo actuamos los anestesólogos?

OBJECTIVE: To determine practices related to control of perioperative hemostasis and transfusion in patients undergoing cardiac surgery in Spain, including the extent to which protocols are being used. METHODS: A questionnaire was created to collect information from physicians in anesthesiology and postoperative recovery care between July 1 and September 20, 2007. The physicians were asked about practice in the 12 months prior to the survey. RESULTS: Thirty-four hospitals responded. Seventy percent reported that they did not have protocols or guidelines for the control of hemostasis during cardiac surgery. Forty-four percent did not have information on the proportion of patients who received transfusions; 47% gave transfusions to 75% of patients. The standard preoperative tests were platelet counts, activated partial thromboplastin time, and prothrombin time. Acetylsalicylic acid and clopidogrel were suspended before surgery at 15 (44%) and 25 (73%) hospitals, respectively. In cases of resistance to heparin, additional doses of the drug were injected, in combination with plasma or antithrombin in 29% and 12% of the hospitals, respectively. In the intensive postoperative recovery care unit, only 1 hospital used thromboelastography. Only 1 other hospital used a platelet function analyzer. CONCLUSIONS: Hemostasis, perioperative coagulation, and criteria for transfusion vary widely among the hospitals surveyed. Few guidelines are available and they are not often being followed. A high percentage of patients receive transfusions, although not all hospitals can cite a figure. New technology has not been widely applied.

Encuesta de hemostasia y transfusión perioperatoria en cirugía cardiaca: ¿cómo actuamos los anestesiólogos? / Survey of perioperative hemostasis and transfusion management in cardiac surgery: how do anesthesiologists practice?

OBJETIVO: Conocer el control perioperatorio de lahemostasia, la práctica transfusional y su grado de protocolizaciónen pacientes intervenidos de cirugía cardiacaen diferentes hospitales de España.MÉTODO: Se elaboró un cuestionario dirigido a facultativosde Anestesiología y Reanimación. Los datos, enreferencia a los 12 meses previos a la encuesta, se recogierondesde el 1 de julio al 20 de septiembre de 2007.RESULTADOS: Se registraron datos de 34 centros, de loscuales el 70% manifestaron no disponer de protocolos oguías sobre el control de la hemostasia en cirugía cardiaca.El 44% de centros desconocían el porcentaje depacientes que habían sido transfundidos. Un 47% de loscentros transfunde más del 75% de los pacientes. Laspruebas estándar en el preoperatorio fueron el recuentode plaquetas, el tiempo parcial de tromboplastina activadoy el tiempo de protombina. El tratamiento preoperatoriocon ácido acetilsalicílico y clopidogrel era suspendidoantes de la cirugía en 15 (44%) y 25 (73%)centros, respectivamente. En caso de resistencia a laheparina, se administraban dosis adicionales de heparina,asociando plasma o antitrombina en el 29% y 12%respectivamente. En UCI/Reanimación, sólo un centroutilizaba tromboelastografía y otro centro utilizabaPFA-100 (analizador de la función plaquetaria).CONCLUSIONES: La hemostasia, la coagulación perioperatoriay los criterios transfusionales varían ampliamenteen los hospitales consultados. Existen pocas guíasy su seguimiento no es amplio. El porcentaje de pacientestransfundidos es elevado, aunque este dato no essiempre conocido. Las nuevas tecnologías no han tenidouna amplia implantación(AU)

OBJECTIVE: To determine practices related to controlof perioperative hemostasis and transfusion in patientsundergoing cardiac surgery in Spain, including theextent to which protocols are being used.METHODS: A questionnaire was created to collectinformation from physicians in anesthesiology andpostoperative recovery care between July 1 andSeptember 20, 2007. The physicians were asked aboutpractice in the 12 months prior to the survey.RESULTS: Thirty-four hospitals responded. Seventypercent reported that they did not have protocols orguidelines for the control of hemostasis during cardiacsurgery. Forty-four percent did not have information onthe proportion of patients who received transfusions;47% gave transfusions to 75% of patients. The standardpreoperative tests were platelet counts, activated partialthromboplastin time, and prothrombin time.Acetylsalicylic acid and clopidogrel were suspendedbefore surgery at 15 (44%) and 25 (73%) hospitals,respectively. In cases of resistance to heparin, additionaldoses of the drug were injected, in combination withplasma or antithrombin in 29% and 12% of thehospitals, respectively. In the intensive postoperativerecovery care unit, only 1 hospital usedthromboelastography. Only 1 other hospital used aplatelet function analyzer.CONCLUSIONS: Hemostasis, perioperative coagulation,and criteria for transfusion vary widely among thehospitals surveyed. Few guidelines are available andthey are not often being followed. A high percentage ofpatients receive transfusions, although not all hospitalscan cite a figure. New technology has not been widelyapplied (AU)