Chu et al.[3232 Chu UB, Clevenger FW, Imami ER, Lampard SD, Frykberg ER, Tepas JJ 3rd.
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To eliminate daily routine phlebotomies |
Dech et al.[3333 Dech ZF, Szaflarski NL. Nursing strategies to minimize blood loss
associated with phlebotomy. AACN Clin Issues. 1996;7(2):277-87.]
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To minimize blood volumes withdrawn for diagnostic test (use small
tubes) |
Lamy et al.[3535 Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et
al; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30
days. N Engl J Med. 2012;366(16):1489-97.]
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To avoid or reduce as much as possible the time of CPB |
Zangrillo et al.[3636 Zangrillo A, Garozzo FA, Biondi-Zoccai G, Pappalardo F, Monaco F, et al.
Miniaturized cardiopulmonary bypass improves short-term outcome in cardiac surgery: a
meta-analysis of randomized controlled studies. J Thorac Cardiovasc Surg.
2010;139(5):1162-9.]
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Mini-circuit systems in CPB reduce blood transfusions |
Boodhwani et al.[3737 Boodhwani M, Williams K, Babaev A, Gill G, Saleem N, Rubens FD.
Ultrafiltration reduces blood transfusions following cardiac surgery: a
meta-analysis. Eur J Cardiothorac Surg. 2006;30(6):892-7.]
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Ultrafiltration reduces hemorrhage and blood transfusions |
Van der Linden et al.[3939 Van der Linden P, De Hert S, Daper A, Trenchant A, Jacobs D, De
Boelpaepe C, et al. A standardized multidisciplinary approach reduces the use of
allogeneic blood products in patients undergoing cardiac surgery. Can J Anesth.
2001;48(9):894-901.]
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Moderate hypotermia (temperature during CPB between 30 and 32ºC) |
Degoute[4040 Degoute CS. Controlled hypotension: a guide to drug choice. Drugs.
2007;67(7):1053-76.]
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Arterial blood pressure at the lowest possible level that mantains
tissue perfusion (MAP of 50-65 mmHg) |
Milas et al.[3434 Milas BL, Jobes DR, Gorman RC. Management of bleeding and coagulopathy
after heart surgery. Semin Thorac Cardiovasc Surg.
2000;12(4):326-36.]
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Meticulous hemostasis (fast and extremaly careful control of
hemorrhages) |
Abrishami et al.[5050 Abrishami A, Chung F, Wong J. Topical application of antifibrinolytic
drugs for on-pump cardiac surgery: a systematic review and meta-analysis. Can J
Anaesth. 2009;56(3):202-12.]
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Topics hemostatics agents to control local bleeding |
Menkis et al.[1616 Menkis AH, Martin J, Cheng DC, Fitzgerald DC, Freedman JJ, Gao C, et al.
Drug, devices, technologies, and techniques for blood management in minimally
invasive and conventional cardiothoracic surgery: a consensus statement from the
International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011.
Innovations (Phila). 2012;7(4):229-41.]
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Pharmacological hemostasis with tranexamic acid or epsilon
animocaproic acid |
Carless et al.[4242 Carless PA, Stokes BJ, Moxey AJ, Henry DA. Desmopressin use for
minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev.
2008;(1):CD001884.]
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Desmopressin increases platelet adhesion and improves hemostasis |
Lin et al.[4545 Lin Y, Stanworth S, Birchall J, Doree C, Hyde C. Recombinant factor VIIa
for the prevention and treatment of bleeding in patients without haemophilia.
Cochrane Database Syst Rev. 2011;(2):CD005011.]
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r-FVIIa to control hemorrhages associated with thrombocytopenia,
disorders of platelet function and preexistent or drug-induced
coagulopaties |
Nienaber et al.[4747 Nienaber U, Innerhofer P, Westermann I, Schöchl H, Attal R, Breitkopf R,
et al. The impact of fresh frozen plasma vs coagulation factor concentrates on
morbidity and mortality in trauma-associated haemorrhage and massive transfusion.
Injury. 2011;42(7):697-701.]
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PCC to rapidly restore the clotting factors and to control major
bleeding |
Rahe-Meyer et al.[4848 Rahe-Meyer N, Hanke A, Schmidt DS, Hagl C, Pichlmaier M. Fibrinogen
concentrate reduces intraoperative bleeding when used as first-line hemostatic
therapy during major aortic replacement surgery: results from a randomized,
placebo-controlled trial. J Thorac Cardiovasc Surg. 2013;145(3
Suppl):S178-85.]
|
Human fibrogen concentrate to replace fibrinogen and to control major
bleeding |
Ferraris et al.[4949 Society of Thoracic Surgeons Blood Conservation Guideline Task Force,
Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, et al; Society of
Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion,
International Consortium for Evidence Based Perfusion. 2011 update to the Society of
Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood
conservation clinical practice guidelines. Ann Thorac Surg.
2011;91(3):944-82.]
|
Human recombinant factor XIII to control major bleedings, when others
hemostatic agents have not produced satisfactory results |
Davies et al.[5353 Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C.
Cost-effectiveness of cell salvage and alternative methods of minimizing
perioperative allogeneic blood transfusion: : a systematic review and economic model.
Health Tech Assess. 2006;10(44):iii-iv, ix-x, 1-210.]
|
Acut normovolemic hemodilution is safe and cost-effective in reducing
allogenic blood transfusion in surgeriess |
Carless et al.[5656 Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA. Cell
salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database
Syst Rev. 2010;(4):CD001888.]
|
Intraoperative blood recovery (cell saver) in surgeries for
autologous blood conservation |