André Soares Santos1, Ananda Jessyla Felix Oliveira2, Maria Carolina Lage Barbosa3, José Luiz Dos Santos Nogueira4. 1. Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, 30.130-100 Belo Horizonte, Brazil.; Department of Economical Sciences, School of Economics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, 31.270-901 Belo Horizonte, Brazil. Electronic address: andresantos111@ufmg.br. 2. Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, 30.130-100 Belo Horizonte, Brazil.; Department of Health Management, School of Nursing, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Santa Efigênia, 30.130-100 Belo Horizonte, Brazil. 3. Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, 30.130-100 Belo Horizonte, Brazil.; Collegy of Pharmacy, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, 31.270-901 Belo Horizonte, Brazil. 4. Centre for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, 30.130-100 Belo Horizonte, Brazil.
Abstract
OBJECTIVE: The aim of this study is to evaluate the safety and efficacy of Viscoelastic Haemostatic Assays (VHA) to guide transfusions in patients undergoing surgical procedures. DESIGN: Systematic review with meta-analysis of randomized controlled trials up until June 5, 2019. SETTING: Hospitalized patients. INTERVENTIONS: VHAs compared to the Standard-Of-Care (SOC), which are represented by standard laboratory tests and/or clinical decisions. MEASUREMENTS: Primary - Risk of death, acute kidney injury, thrombotic events and reoperation for bleeding; Secondary - Risk of use of red blood cells (RBC), platelets, fresh frozen plasma (FFP), fibrinogen, factor VIIa, prothrombin complex, volume of RBC, platelets and FFP, length of hospital stay, and length of ICU stay. RESULTS: VHAs were associated to a statistically significant reduction in mortality (7.3% vs. 12.1%; RR = 0.64, p-value = 0.03), risk of acute kidney injury (10.5% vs. 17.6%; RR = 0.53, p-value = 0.005), volume of red blood cells (RBCs) transfused (MD = -1.63 U, p-value = 0.02), risk of platelet transfusion (23.9% vs. 27.3%; RR = 0.74, p-value = 0.006), risk of fresh frozen plasma (FFP) transfusion (RR = 0.57, p-value = 0.001), and volume of FFP transfused (MD = -0.90, p-value = 0.0003). No significant differences were observed in terms of thrombotic events, reexploration for bleeding, RBC transfusion, volume of platelets transfused, use of fibrinogen, prothrombin complex, or factor VIIa, length of hospitalization and length of ICU stay. CONCLUSION: Viscoelastic haemostatic assays are safe and efficacious for coagulation control in patients undergoing surgical procedures, therefore it should be considered for use in practice.
OBJECTIVE: The aim of this study is to evaluate the safety and efficacy of Viscoelastic Haemostatic Assays (VHA) to guide transfusions in patients undergoing surgical procedures. DESIGN: Systematic review with meta-analysis of randomized controlled trials up until June 5, 2019. SETTING: Hospitalized patients. INTERVENTIONS: VHAs compared to the Standard-Of-Care (SOC), which are represented by standard laboratory tests and/or clinical decisions. MEASUREMENTS: Primary - Risk of death, acute kidney injury, thrombotic events and reoperation for bleeding; Secondary - Risk of use of red blood cells (RBC), platelets, fresh frozen plasma (FFP), fibrinogen, factor VIIa, prothrombin complex, volume of RBC, platelets and FFP, length of hospital stay, and length of ICU stay. RESULTS: VHAs were associated to a statistically significant reduction in mortality (7.3% vs. 12.1%; RR = 0.64, p-value = 0.03), risk of acute kidney injury (10.5% vs. 17.6%; RR = 0.53, p-value = 0.005), volume of red blood cells (RBCs) transfused (MD = -1.63 U, p-value = 0.02), risk of platelet transfusion (23.9% vs. 27.3%; RR = 0.74, p-value = 0.006), risk of fresh frozen plasma (FFP) transfusion (RR = 0.57, p-value = 0.001), and volume of FFP transfused (MD = -0.90, p-value = 0.0003). No significant differences were observed in terms of thrombotic events, reexploration for bleeding, RBC transfusion, volume of platelets transfused, use of fibrinogen, prothrombin complex, or factor VIIa, length of hospitalization and length of ICU stay. CONCLUSION: Viscoelastic haemostatic assays are safe and efficacious for coagulation control in patients undergoing surgical procedures, therefore it should be considered for use in practice.
Authors: Sebastian D Sahli; Julian Rössler; David W Tscholl; Jan-Dirk Studt; Donat R Spahn; Alexander Kaserer Journal: Sensors (Basel) Date: 2020-07-30 Impact factor: 3.576