The Use of Factor Eight Inhibitor Bypass Activity (FEIBA) for the Treatment of Perioperative Hemorrhage in Left Ventricular Assist Device Implantation.

Autor: O'Donnell C; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA., Rodriguez AJ; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA., Madhok J; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA., Sharifi H; Department of Medicine (Pulmonary, Allergy & Critical Care Medicine), Stanford University School of Medicine, Stanford, CA., Wang H; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA., O'Brien CG; Department of Cardiovascular Medicine, University of California, San Francisco, CA., Boyd J; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA., Hiesinger W; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA., Hsu J; Department of Medicine (Pulmonary, Allergy & Critical Care Medicine), Stanford University School of Medicine, Stanford, CA., Hill CC; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA. Electronic address: chill1@stanford.edu.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2021 Sep; Vol. 35 (9), pp. 2651-2658. Date of Electronic Publication: 2021 Apr 25.
DOI: 10.1053/j.jvca.2021.04.030
Abstrakt: Objective: To test the hypothesis that factor eight inhibitor bypassing activity (FEIBA) can be used to control bleeding following left ventricular assist device (LVAD) implantation without increasing the 14-day composite thrombotic outcome of pump thrombus, ischemic cerebrovascular accidents, pulmonary embolism, and deep venous thrombosis.
Design: Retrospective cohort study.
Setting: Academic hospital.
Participants: Three hundred nineteen consecutive patients who underwent LVAD implantation (December 1, 2009 to December 30, 2018).
Intervention: FEIBA administered to control perioperative hemorrhage.
Measurements and Main Results: The 82 patients (25.7%) in the FEIBA cohort had more risk factors for perioperative hemorrhage, such as lower preoperative platelet count (169 ± 66 v 194 ± 68 × 10 3 /mL, p = 0.004), prior cardiac surgery (36.6% v 21.9%, p = 0.008), and longer cardiopulmonary bypass (CPB) time (100.3 v 75.2 minutes, p = 0.001) than the 237 controls. After 16.6 units (95% CI: 14.3-18.9) of blood products were given, 992 units (95% CI: 821-1163) of FEIBA were required to control bleeding in the FEIBA cohort. Compared to the controls, there were no differences in the 14-day composite thrombotic outcome (11.0% v 7.6%, p = 0.343) or mortality rate (3.7% v 1.3%, p = 0.179). Multivariate logistical regression identified preoperative international normalized ratio (odds ratio [OR]: 1.30, 95% CI: 1.04-1.62) and CPB time (OR: 1.11, 95% CI: 1.02-1.20) as risk factors for 14-day thrombotic events, but FEIBA usage was not associated with an increased risk.
Conclusions: In this retrospective cohort study, the use of FEIBA (∼1,000 units, ∼13 units/kg) to control perioperative hemorrhage following LVAD implantation was not associated with increases in mortality or composite thrombotic outcome.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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