Search PubMed⌕ Search
Home/Archive/PubMed

PubMed · 10475475

Preventing, minimizing, and managing postoperative bleeding.

A Pavie·J Szefner·P Leger·I Gandjbakhch
View original source ↗Export metadata ↓

Abstract

BACKGROUND: Most bleeding in cardiovascular surgery is biological, not surgical, the result of disseminated intravascular coagulation in its latter phases. Disseminated intravascular coagulation bleeding affects all levels of the coagulation systems, requiring stabilization of the platelet system, balancing the procoagulant system and its regulation, and stopping the fibrinolytic system's activation. METHODS: The article discusses the multisystem protocol put into place at the Cardiovascular Surgery Department of La Pitié Hospital in Paris to diagnose and treat DIC bleeding so as to slow down causes of its occurrence and prevent further deterioration of the hemostatic systems. RESULTS: All biological bleeding was controlled, permitting detection of other causes of bleeding and allowing rational use of blood products. No thromboembolic accident occurred. There was an absence of iatrogenic bleeding. The protocol also detects disseminated intravascular coagulation in patients who did not bleed to take early and frequently lifesaving measures. CONCLUSIONS: This demonstrates the need to treat bleeding through a multisystem approach, monitoring its evolution by means of biological tests to be able to provide appropriate treatment.

Explore related subjects

Blood Coagulation TestsDisseminated Intravascular CoagulationHeart-Assist DevicesHemostasis, SurgicalHumansParisPostoperative HemorrhageRisk FactorsJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

A Pavie, J Szefner, P Leger, I Gandjbakhch. 1999. Preventing, minimizing, and managing postoperative bleeding.. https://doi.org/10.1016/s0003-4975(99)00628-1

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

In vitro kinetics of factor VIII activity in patients with mild haemophilia A and a discrepancy between one-stage and two-stage factor VIII assay results.

In some mild haemophilia A patients (discrepant haemophilia), factor VIII coagulant activity (FVIII:C) levels, by one-stage assay are more than double than those by two-stage assay. This may be due to the longer incubation times (10-12 min) in the two-stage assay. This study aimed to determine the time course of the activation phase of the two-stage assay, using both classical coagulation and chromogenic detection methods. In both systems, for equivalent patients (equivalent FVIII:C levels by one-stage and two-stage assays, n = 6, all different mutations), similar FVIII:C results were obtained with short- or long-incubation times. In contrast, plasma from discrepant patients (n = 8, five different mutations) showed higher FVIII:C at shorter incubation times than after longer incubation times. In the chromogenic assay, FVIII:C levels were higher after incubation for 2 min (23-56%, mean 41%) than after 10 min (19-41%, mean 29%). In the classical coagulation assay, FVIII:C levels were higher at shorter incubation times (21-64%, mean 37%) than with the longer incubation times usually used (13-29%, mean 23%). These time-course experiments have verified that the longer incubation time used in the two-stage assay is at least partly responsible for the lower FVIII:C measured by that assay in discrepant haemophilia.

Blood Coagulation Tests↗
PubMed2007

Von Willebrand disease within the collective of haemophilic patients as reason for unexpected bleeding episodes.

In the treatment of haemophilia A and B, recombinant coagulation factors are increasingly replacing plasma-derived factor VIII and IX concentrates. Although provided with replacement therapy, individual patients may exhibit bleeding episodes, which are difficult to control. These bleeds may be caused by von Willebrand disease (VWD) as an additional underlying coagulation disorder. We report in the present study our experience that in the collective of haemophilic patients, VWD must be anticipated at least with the same order of magnitude as it appears in a normal healthy population. Among the patients at our treatment centre, two patients (1.5%) were identified as suffering from VWD in addition to haemophilia A. In the collective of haemophilia B patients at our centre, three patients (10%) with VWD were found. Two of these patients exhibited unexpected severe bleeding episodes, which could only satisfactorily be controlled by the administration of Haemate-P or DDAVP supplementary to the recombinant coagulation factor concentrate.

Blood Coagulation Tests↗