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1.
The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement: a prospective study on 60 patients
Qu Z, Wang G, Xu C, Zhang D, Qu X, Zhou H, Ma J
International Journal of Surgery (London, England). 2016;34:58-63
Abstract
BACKGROUND Preoperative platelet rich plasma (PRP) harvest has been used in cardiopulmonary surgery for more than 10 years. There is no previous study dealing with PRP in bilateral total hip replacement. This study was to investigate the effects of PRP on blood saving and blood coagulation function in patients with bilateral total hip replacement. PATIENTS AND METHODS A prospective, randomized, clinical trial was conducted. Sixty patients were enrolled, including 30 patients undergoing PRP in the PRP group and 30 controls. The surgery time, total transfusion volume, blood loss, allogenic blood transfusion, autologous blood transfusion, urine volume, drainage volume, some blood parameters (including Fibrinogen, D-dimer, Prothrombin time, international normalizedratio, activated partial thromboplastin time, Platelet, Haemoglobin B), thrombelastogram (TEG) and blood-gas parameters were studied in the perioperative stage. The measurement data were analyzed statistically. RESULTS There was no statistical difference between the two groups in baseline characteristics, surgery time, total transfusion volume, blood loss, autologous blood transfusion, etc. Allogenic blood transfusion in the PRP group was less than the control group with statistical difference (p=0.024). Fibrinogen in the PRP group was higher than the control group (p=0.008). Among the TEG indicators, activated clotting time and coagulation time K in the PRP group were less than the control group. Clotting rate and maximum amplitude in the PRP group were higher. The blood-gas parameters presented no statistical difference. CONCLUSION The results suggested that PRP probably played a positive role in blood coagulation function as well as blood saving in patients with bilateral total hip replacement.
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2.
Effectiveness of preoperative autologous plateletpheresis combined with intraoperative autotransfusion on the blood coagulation in orthopaedic patients
Zhang XF, Dong JM, Gong ML, Shen SM, Zhou Y, Pan YF, Mao JP
Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]. 2008;46((2):):118-21.
Abstract
OBJECTIVE To investigate the effectiveness of preoperative plateletpheresis combined with intraoperative autotransfusion on the blood coagulation of orthopaedic patients. METHODS Sixty patients (ASA I-II) undergoing selective orthopaedic surgery were randomized into three groups (n = 20), that is, preoperative plateletpheresis combined with intraoperative autotransfusion for group I, intraoperative autotransfusion for group II, and group III without any managements of blood conservation. Coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen), hemoglobin and hematocrit values, platelet counts and aggregability were evaluated before the anaesthesia, 10 minutes after plateletpheresis, 10 minutes before the infusion of platelet rich plasma or autologous blood, 10 minutes after infusion, 24 and 48 hours postoperation. Intra- and postoperation blood loss and homologous blood transfusion requirements were also recorded. RESULTS Among three groups, there were no differences in intraoperative blood loss, perioperative haemoglobin level (Hb and Hct). As compared with group I, significant lower level of platelet counts and aggregability were observed in group II and III at the time of 24 and 48 hours after operation (P < 0. 05), while postoperation blood loss and homologous blood-transfusion requirements increased at the same period (P < 0. 01). CONCLUSIONS Preoperative plateletpheresis combined with intraoperative autotransfusion can ameliorate the blood coagulation in orthopaedic patients, and it is an effective way to decrease blood loss and homologous blood-transfusions requirements.
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3.
Combination of acute preoperative plateletpheresis, cell salvage, and aprotinin minimizes blood loss and requirement during cardiac surgery
Li S, Ji H, Lin J, Lenehan E, Ji B, Liu J, Liu J, Long C, Crane TA
The Journal of Extra-Corporeal Technology. 2005;37((1):):9-14.
Abstract
Acute preoperative plateletpheresis (APP), cell salvage (CS) technique, and the use of aprotinin have been individually reported to be effective in reducing blood loss and blood component transfusion while improving hematological profiles in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this prospective randomized clinical study, the efficacy of these combined approaches on reducing blood loss and transfusion requirements was evaluated. Seventy patients undergoing primary coronary artery bypass grafting (CABG) were randomly divided into four groups: a control group (group I, n = 10) did not receive any of the previously mentioned approaches. An APP and CS group (group II, n = 20) experienced APP in which preoperative platelet-rich plasma was collected and reinfused after reversal of heparin, along with the cell salvage technique throughout surgery. The third group (group III, n = 22) received aprotinin in which 5,000,000 KIU Trasylol was applied during surgery, and a combination group (group IV, n = 18) was treated with all three approaches, i. e. , APP, CS, and aprotinin. Compared with group I (896+/-278 mL), the postoperative total blood loss was significantly reduced in groups II, III, and IV (468+/-136, 388+/-122, 202+/-81 mL, respectively, p < 0. 05). The requirements of packed red blood cells in the three approached groups (153+/-63, 105+/-178, 0+/-0 mL, respectively) also were reduced when compared with group I (343+/-118 mL, p < 0. 05). In group I, six patients (6/10) received fresh-frozen plasma and three patients (3/10) received platelet transfusion, whereas no patients in the other three groups required fresh-frozen plasma and platelet. In conclusion, both plateletpheresis concomitant with cell salvage and aprotinin contribute to the improvement of postoperative hemostasis, and the combination of these two approaches could minimize postoperative blood loss and requirement.
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4.
Plateletpheresis the day before cardiac surgery and the impairment of platelet function
Fattorutto M, Pradier O, Jansens JL, Ickx B, Barvais L
European Journal of Anaesthesiology. 2003;20((4):):338-40.
Abstract
The pathogenesis of the platelet qualitative defect after cardiopulmonary bypass (CPB) remains incompletely elucidated [1]. Theoretically, the collection of platelets before CPB followed by their transfusion immediately at the end of CPB would result in improved haemostasis. We decided to study the effect of autologous plateletpheresis the day before surgery on platelet function and mediastinal blood loss. After institutional review board approval and written informed consent, patients scheduled for cardiac surgery were prospectively enrolled. Cardiac procedures with expected CPB longer than 2 h represented the target population. Twenty patients with normal coagulation function, platelet counts and withdrawal of antiplatelet drugs for at least 7 days before the operation were randomized for either the control group (n =10) or the apheresis group (n =10). The day before surgery, platelet collection was performed with a cell separator (COBE Spectra LRS®, Denver, CO, USA). The platelets were stored for 24 h in an incubator (Helmer, Nobelsville, IA, USA). Surgical procedures were performed with standard CPB techniques at moderate systemic hypothermia (32°C). Aprotinin was infused to all patients. Heparin was given at an initial dosage of 300 IU kg-1, supplemented to maintain an activated coagulation time (ACT) greater than 480 s and ‘reversed’ with protamine sulphate to return ACT to baseline. Autologous platelets were infused at the end of CPB. Blood samples were collected after induction of anaesthesia (T1), after completion of CPB and protamine-induced heparin neutralization (T2), 30 min after protamineinduced antagonism of heparin and after completion of autologous platelet infusion in the apheresis group (T3), 4 h after heparin neutralization (T4) for measurements of platelet count, haemoglobin concentration and platelet aggregation. Photo-optical aggregometry was used (Platelet Aggregation Profiler-4®; Bio Data Corporation, Hatboro, PA, USA). Briefly, platelet-rich and -poor plasmas were obtained by centrifuging whole blood at 1000 and 3000 rpm, respectively. The aggregometer was calibrated. One agonist was added to platelet-rich plasma: ristocetin (Paesel Lorei®, Hanau, Germany) 1.2mgmL_1, adenine diphosphate (ADP®; Boehringer, Mannheim, Germany) 5 µmol L-1, collagen (collagen reagent Horin®, Munich, Germany) 2.5 µgmL-1. In both groups, the same algorithm was applied for transfusion requirements. Mediastinal blood loss was recorded during the second, 12th and 24th h. Continuous variables were expressed as mean ± standard deviation. Blood losses were expressed as median and interquartile ranges (2575%). Comparisons for continuous variables between groups were made using the U-test; comparisons between the groups, for discrete variables, were made with Fisher’s exact test; a Spearman’s rank correlation test was used. P < 0.05 was considered as being statistically significant. Patient characteristics and preoperative haematological variables were similar among patients of both groups. The control and apheresis groups did not differ significantly for the duration of CPB (137 ± 20 vs. 144 ± 36 min). In the apheresis group, a mean of 13 ± 2 1011 platelets was collected. Mediastinal blood losses were quite similar with a median of 720 (640975) mL during the first 24 h in the control group vs. 820 (745885) mL in the apheresis group. No difference was noted at any time with reference to haemoglobin concentration or platelet aggregation (Table 1). Four hours after infusion of the autologous stored platelets (T4), the platelet count was not significantly higher in the apheresis group than in the control group (162 ± 50 vs. 154 ± 55 103µL-1). One of the most important findings of the study in the apheresis group was that platelet aggregation did not improve either after platelet infusion or 4 h after completion of CPB. After protamine administration, ADP and ristocetin induced-platelet aggregation demonstrated a significant negative correlation with a mediastinal blood loss at the 12th postoperative hou
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5.
Preoperative autologous plateletpheresis in patients undergoing open heart surgery
Tomar AS, Tempe DK, Banerjee A, Hegde R, Cooper A, Khanna SK
Annals of Cardiac Anaesthesia. 2003;6((2)):136-42.
Abstract
Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP) can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP) harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I) in which one unit of whole blood was withdrawn, and PRP group (Group II) where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001) and required 38.5% less homologous blood and blood products (p<0.05), in the postoperative period. Haemoglobin levels on day zero (day of operation) and day three were statistically not different between the two groups. We conclude that autologous plateletpheresis is a better method of blood conservation in terms of better haemostasis, and less requirement of blood and blood products in the postoperative period as compared with the autologous whole blood donation. This technique can be especially useful in the above-mentioned categories of patients.
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6.
Platelet pheresis is not a useful adjunct to blood-sparing strategies in cardiac surgery
Ford SM, Unsworth-White MJ, Aziz T, Tooze JA, van Besouw JP, Bevan DH, Treasure T
Journal of Cardiothoracic & Vascular Anesthesia. 2002;16((3):):321-9.
Abstract
OBJECTIVE To examine whether specific platelet pheresis (minimal plasma harvested) would contribute toward reduced blood loss and allogenic blood requirements after cardiac surgery. DESIGN A prospective randomized trial. SETTING A large cardiothoracic surgical center. PARTICIPANTS Consenting patients undergoing routine coronary artery or valve surgery (n = 54). INTERVENTIONS Patients in the pheresis group underwent platelet pheresis in the anesthetic preparation room before general anesthesia. Pheresed platelets were stored during cardiopulmonary bypass and were returned to the patients after reversal of heparin with protamine toward the end of surgery. Control patients underwent their operations without this intervention. MEASUREMENTS AND MAIN RESULTS Primary endpoints were blood loss and transfusion requirements. There were no differences between the 2 groups (pheresis v control: median loss, 960 mL v 1100 mL, p = 0.15; median blood transfused, 896 mL v 635 mL, p = 0.71). Secondary endpoints included analysis of platelet counts, platelet function, and surface markers. Counts remained the same after retransfusion of platelets up to 2 hours after surgery. Platelet aggregation to ristocetin was well preserved, but adenosine diphosphate caused almost no aggregation of the harvested platelets. Flow cytometry revealed the platelets to have a reduced surface density of the glycoprotein 1b receptor, and 13% of them were irreversibly activated. CONCLUSION Platelet pheresis activates a proportion of the harvested platelets and impairs the function of the remainder; this may explain its failure to reduce postoperative blood loss and transfusion requirements. Copyright 2002, Elsevier Science (USA). All rights reserved.
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7.
Intraoperative plateletpheresis and autologous platelet gel do not reduce chest tube drainage or allogeneic blood transfusion after reoperative coronary artery bypass graft
Wajon P, Gibson J, Calcroft R, Hughes C, Thrift B
Anesthesia & Analgesia. 2001;93((3):):536-42.
Abstract
Platelet-rich plasma (PRP) is postulated to decrease postoperative mediastinal chest tube drainage (MCTD) and allogeneic blood transfusions (ABT) after surgery with cardiopulmonary bypass. However, recent metaanalysis of the literature reveals that few good quality (therapeutic yield) trials that show a benefit have been published. The potential hemodynamic instability caused by plateletpheresis has not been emphasized. We studied the effect of plateletpheresis on MCTD, ABT, and hemodynamic stability in reoperative coronary artery bypass graft patients, a group perceived to be at high risk for ABT. Ninety patients were randomly assigned to Pheresis or Control groups. epsilon-Aminocaproic acid was given to all patients. Hemodynamic instability was assessed by degree of volume and inotrope resuscitation required. Part of the sequestered platelet volume was used to make autologous platelet gel, which was applied as a wound sealant. Mean pheresis yield was 30% +/- 7% of the circulating platelet mass or 6.4 +/- 2.2 allogeneic platelet unit equivalents. Total MCTD did not differ between the groups. There were no differences in mean packed red blood cell, platelet, and plasma transfusion rates. Overall, 52% of the Pheresis group received ABT, versus 55% of the Control group. Fifty-three percent of the Pheresis group patients exhibited significant hemodynamic instability, versus 27% of the Control group (P < 0.05). This study was unable to show any reduction in MCTD or ABT, although the plateletpheresis technique may offset platelet dysfunction caused by aspirin or increased blood exposure to nonbiologic surfaces, or it may compensate for lack of antifibrinolytic use. The significantly increased incidence of hemodynamic instability in the Pheresis group means that the risk/benefit ratio must be determined for individual cardiac surgical units.
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8.
Plateletpheresis before redo CABG diminishes excessive blood transfusion
Christenson JT, Reuse J, Badel P, Simonet F, Schmuziger M
Annals of Thoracic Surgery. 1996;62((5):):1373-8; discussion 1378-9.
Abstract
BACKGROUND Blood conservation remains an important element for patients undergoing cardiac operations with cardiopulmonary bypass. Preoperative platelet-rich plasma (PRP) harvest is an autologous blood conservation method. The efficacy of preoperative PRP harvest and post-cardiopulmonary bypass reinfusion on postoperative bleeding and need for postoperative blood transfusion was evaluated in patients undergoing redo coronary artery bypass grafting in a prospective, randomized manner. METHODS All adult patients admitted for redo coronary artery bypass grafting entered into the study. The PRP harvest aim was 20% or more of the total estimated circulating platelets. Immediately preoperatively three sequestration cycles were performed. The PRP was reinfused after weaning from cardiopulmonary bypass. One hundred seven parameters/patient were recorded. There were 20 patients in the RPR group and 20 controls (without PRP harvest). RESULTS Patient characteristics, operative data, and preoperative hematologic parameters did not differ between the groups. In the PRP group, the mean platelet count in the PRP was 864 +/- 139 x 10(3)/microL, and the platelet yield was 27% +/- 5% (range, 20% to 37%). The average total chest tube blood loss was 423 mL (PRP) compared with 1,462 mL (controls; p < 0.001). Fourteen patients in the control group required blood transfusions postoperatively compared with only 1 patient in the PRP group (p < 0.001). Postoperative fluid requirements were also significantly greater in the control group (p < 0.001). Postextubation gas exchange was significantly better in the PRP group compared with controls (p < 0.01). Postoperative ventilation time and intensive care stay were significantly shorter in patients in the PRP group. CONCLUSIONS A preoperative PRP harvest of 20% or more of the total platelets and reinfusion of the PRP after cardiopulmonary bypass resulted in significantly less postoperative blood loss and decreased fluid and blood transfusion requirements compared with controls. Postextubation gas exchange, ventilation time, and time required in the intensive care unit were also better, and the method was found cost-effective.
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9.
Extracorporeal fibrinogen and platelet precipitation as a new haemorheological treatment for acute stroke
Walzl B, Walzl M, Lechner H
Journal of the Neurological Sciences. 1994;126((1):):25-9.
Abstract
In thromboembolic brain infarctions high fibrinogen levels are associated with an increase of both plasma and whole blood viscosity as well as increased aggregability of blood cells. This decreases cerebral perfusion and might reduce blood flow in the penumbra surrounding infarction. An important goal in the treatment of acute cerebral infarction is to reduce fibrinogen and thereby improve the haemorheological state. Heparin-induced extracorporeal low-density lipoprotein/fibrinogen precipitation (HELP) appears to be successful in achieving this. Such treatment reduces lipid fractions, including total cholesterol, low-density lipoproteins (LDL) and triglycerides (p < 0.0001 each), as well as fibrinogen (p < 0.0001) in a safe and efficacious manner. Whole blood and plasma viscosity are also improved when measured by oscillo-rheometry. Furthermore, the number and aggregation tendency of blood cells is influenced positively as determined by Coulter counting and aggregometry. HELP improves the haemorheological profile to a degree which has not been achieved by haemorheologically active substances.
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10.
Preoperative plateletpheresis does not reduce blood loss during cardiac surgery
Boey SK, Ong BC, Dhara SS
Canadian Journal of Anaesthesia. 1993;40((9):):844-50.
Abstract
Acute preoperative plateletpheresis has been reported to be effective in reducing blood loss and blood component transfusion while improving haematological profiles in patients undergoing open-heart surgery. However, in these studies, the concomitant use of cell saver techniques may have been responsible for the beneficial effects because they remove free haemoglobin and activated procoagulants and, therefore, could mask the deleterious effects of combined plateletpheresis and cardiopulmonary bypass (CPB). In the present study, 40 patients undergoing primary myocardial revascularization were randomly divided into two groups: a control group without plateletpheresis performed, and a second group in which preoperative platelet-rich plasma 10 ml.kg-1 (PRP group) was collected and later reinfused after reversal of heparin. Standardized surgery, anaesthesia and CPB without concomitant cell saver techniques were employed. In the PRP group, blood transfusion was reduced (1.5 +/- 1.3 vs 2.4 +/- 1.3 units, P < 0.05) but this was accompanied by lower postoperative haemoglobin concentrations. There were no differences in blood loss (992.6 +/- 327.4 vs 889.6 +/- 343.7 ml), fresh frozen plasma (2/19 vs 3/20 patients) or platelet requirements (1/19 vs 1/20 patients). Reinfusion of autologous PRP did not improve platelet count and function, nor tests of coagulation. Fibrinogen concentrations were lower in the PRP group on the operative day (P < 0.05), suggesting increased fibrinogen consumption; and more patients in the PRP group had low haptoglobin levels during CPB (8/19 vs 0/20 patients, P < 0.005), which indicated greater haemolysis in this group. We conclude that acute preoperative plateletpheresis offers no advantage in haemostasis during elective primary myocardial revascularization surgery.