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Article ; Online: Massive transfusion protocol: What's in a name?

Klompas, Allan M / Stubbs, James

2023 Volume 63, Issue 4, Page(s) 896–897

MeSH term(s)	Humans ; Blood Transfusion
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.17297
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Article ; Online: Resisting arrest: Perioperative confirmation and management of an iatrogenic aortocoronary arteriovenous fistula after coronary artery bypass grafting for redo cardiac surgery.

Klompas, Allan M / Kawajiri, Hidetake / Sinak, Lawrence J / Pochettino, Alberto

Annals of cardiac anaesthesia

2023 Volume 26, Issue 1, Page(s) 83–85

Abstract: Although rare, iatrogenic aortocoronary arteriovenous fistulae (ACAVF) occur when a coronary graft is mistakenly anastomosed to an epicardial vein rather than its intended arterial target. Patients may be asymptomatic, demonstrate angina, dyspnea, ... ...

Abstract	Although rare, iatrogenic aortocoronary arteriovenous fistulae (ACAVF) occur when a coronary graft is mistakenly anastomosed to an epicardial vein rather than its intended arterial target. Patients may be asymptomatic, demonstrate angina, dyspnea, arrhythmias, syncope, or diminished exercise capacity, and may have wide pulse pressures with evidence of coronary steal. A thorough insight into the disordered anatomy is critical to safely manage a patient for redo cardiac surgery, especially when attempting to arrest the heart. We present a case for redo cardiac surgery of an iatrogenic ACAVF confirmed perioperatively with multiple modalities and its intraoperative management.
MeSH term(s)	Humans ; Cardiac Surgical Procedures ; Coronary Artery Bypass ; Heart ; Angina Pectoris ; Arteriovenous Fistula/diagnostic imaging ; Arteriovenous Fistula/etiology ; Arteriovenous Fistula/surgery
Language	English
Publishing date	2023-02-01
Publishing country	India
Document type	Case Reports
ZDB-ID	2106866-5
ISSN	0974-5181 ; 0971-9784
ISSN (online)	0974-5181
ISSN	0971-9784
DOI	10.4103/aca.aca_310_20
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Article ; Online: Role of individual factor X concentrate pharmacokinetic studies in perioperative management of AL amyloidosis-associated acquired factor X deficiency.

Lewis, Akeem R / Peffley, Nathan / Klompas, Allan M / Ashrani, Aneel A

Transfusion

2023 Volume 63, Issue 9, Page(s) 1773–1777

Abstract: Background: AL amyloidosis is associated with acquired factor X (FX) deficiency. Experience related to its management is limited to case reports and series using prothrombin complex concentrate, fresh frozen plasma, plasma exchange, recombinant ... ...

Abstract	Background: AL amyloidosis is associated with acquired factor X (FX) deficiency. Experience related to its management is limited to case reports and series using prothrombin complex concentrate, fresh frozen plasma, plasma exchange, recombinant activated factor seven, and desmopressin with limited and variable efficacy. FX concentrate has not been widely used in its management. Study design and methods: We report our experience with the perioperative use of FX concentrate (Coagadex) in two patients with AL amyloidosis-associated acquired FX deficiency requiring surgery, using their individual pharmacokinetic studies to manage perioperative hemostasis. Pharmacokinetic studies involved obtaining post-infusion FX activity at 10 min, 2, and 4 h following the administration of FX concentrate to calculate the FX half-life. Results: Both patients' plasma FX activity was successfully increased to provide perioperative hemostatic support. Monitoring FX activity post-surgery was also utilized to maintain FX activity levels to prevent post-operative bleeding. Conclusion: Pharmacokinetic studies have a useful role in tailoring preoperative FX repletion in patients with AL amyloidosis associated with acquired FX deficiency.
MeSH term(s)	Humans ; Factor X/therapeutic use ; Immunoglobulin Light-chain Amyloidosis/complications ; Immunoglobulin Light-chain Amyloidosis/therapy ; Factor X Deficiency/complications ; Postoperative Hemorrhage
Chemical Substances	Factor X (9001-29-0)
Language	English
Publishing date	2023-07-10
Publishing country	United States
Document type	Case Reports ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.17477
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Article ; Online: Contemporary Perioperative Management of Direct Oral Anticoagulants.

Ripoll, Juan G / Klompas, Allan M / Smith, Bradford B / Smith, Mark M

Advances in anesthesia

2022 Volume 40, Issue 1, Page(s) 93–109

Abstract: Direct oral anticoagulants (DOACs) have rapidly emerged as popular alternatives to warfarin in the setting of nonvalvular atrial fibrillation, prevention and treatment of venous thromboembolism, and secondary prevention of arterial thrombosis. It is now ... ...

Abstract	Direct oral anticoagulants (DOACs) have rapidly emerged as popular alternatives to warfarin in the setting of nonvalvular atrial fibrillation, prevention and treatment of venous thromboembolism, and secondary prevention of arterial thrombosis. It is now estimated that more patients in the United States take DOACs than warfarin for approved indications. Studies to date have shown that these drugs are similarly efficacious with perhaps a lower bleeding risk than warfarin. The purpose of this review is to provide insight into the currently available DOACs and discuss the management and reversal strategies for patients in the perioperative period.
MeSH term(s)	Humans ; Warfarin/therapeutic use ; Administration, Oral ; Anticoagulants/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/complications ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/prevention & control ; Venous Thromboembolism/complications
Chemical Substances	Warfarin (5Q7ZVV76EI) ; Anticoagulants
Language	English
Publishing date	2022-11-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632613-4
ISSN	1878-0415 ; 0737-6146
ISSN (online)	1878-0415
ISSN	0737-6146
DOI	10.1016/j.aan.2022.06.002
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Article ; Online: Postoperative Transfusions after Administration of Delayed Cold-stored Platelets versus Room Temperature Platelets in Cardiac Surgery: A Retrospective Cohort Study.

Klompas, Allan M / Zec, Simon / Hanson, Andrew C / Weister, Tim / Stubbs, James / Kor, Daryl J / Warner, Matthew A

Anesthesiology

2023 Volume 139, Issue 2, Page(s) 153–163

MeSH term(s)	Adult ; Humans ; Blood Platelets ; Platelet Transfusion ; Temperature ; Retrospective Studies ; Cardiac Surgical Procedures ; Blood Preservation
Language	English
Publishing date	2023-05-06
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000004605
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Uk I Zs.133: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 199: Show issues

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Article ; Online: Thrombocytopenia: Perioperative Considerations for Patients Undergoing Cardiac Surgery.

Klompas, Allan M / Boswell, Michael R / Plack, Daniel L / Smith, Mark M

Journal of cardiothoracic and vascular anesthesia

2021 Volume 36, Issue 3, Page(s) 893–905

Abstract: The etiologies of thrombocytopenia in patients presenting for cardiac surgery are extensive, but clinically relevant conditions generally can be categorized by those related to decreased platelet production or increased platelet destruction. Many causes ... ...

Abstract	The etiologies of thrombocytopenia in patients presenting for cardiac surgery are extensive, but clinically relevant conditions generally can be categorized by those related to decreased platelet production or increased platelet destruction. Many causes require mere acknowledgment and availability of allogeneic platelet transfusion; others have unique considerations for which providers should be familiar. The purpose of this review is to provide an overview of the common causes of thrombocytopenia, summarize the literature, and discuss perioperative considerations for patients undergoing cardiac surgery.
MeSH term(s)	Anemia/complications ; Cardiac Surgical Procedures/adverse effects ; Humans ; Platelet Transfusion ; Thrombocytopenia/diagnosis ; Thrombocytopenia/etiology
Language	English
Publishing date	2021-02-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2021.02.009
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The Triple HIT: Perioperative Management of Heparin-Induced Thrombocytopenia Using Plasma Exchange, Intravenous Immunoglobulin, and Protamine Infusion for Left Ventricular Assist Device Implantation.

Liu, Victor C / Klompas, Allan M / Stulak, John M / Yalamuri, Suraj M

Journal of cardiothoracic and vascular anesthesia

2021 Volume 36, Issue 6, Page(s) 1715–1719

Abstract: Heparin-induced thrombocytopenia (HIT) is a serious complication in patients exposed to heparin, leading to thrombocytopenia and, potentially, thrombosis. This disorder is challenging in cardiac surgery when anticoagulation for cardiopulmonary bypass is ... ...

Abstract	Heparin-induced thrombocytopenia (HIT) is a serious complication in patients exposed to heparin, leading to thrombocytopenia and, potentially, thrombosis. This disorder is challenging in cardiac surgery when anticoagulation for cardiopulmonary bypass is required. Herein a patient with HIT who had active thrombosis and successfully underwent urgent left ventricular assist device implantation managed with plasma exchange, intravenous immunoglobulin, and protamine infusion is described. These therapies reduce the immune response to heparin and minimize thrombosis when heparin reexposure is planned. These approaches to perioperative management of HIT represent an attractive alternative to the use of non-heparin anticoagulants in the cardiac and vascular surgical population.
MeSH term(s)	Anticoagulants/adverse effects ; Heart-Assist Devices/adverse effects ; Heparin/adverse effects ; Humans ; Immunoglobulins, Intravenous/adverse effects ; Plasma Exchange/adverse effects ; Protamines/adverse effects ; Thrombocytopenia/chemically induced ; Thrombocytopenia/complications ; Thrombocytopenia/therapy ; Thrombosis/complications ; Thrombosis/therapy
Chemical Substances	Anticoagulants ; Immunoglobulins, Intravenous ; Protamines ; Heparin (9005-49-6)
Language	English
Publishing date	2021-03-30
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2021.03.037
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Emergent pulmonary thromboembolectomy and atrial septal aneurysmectomy for intracardiac impending paradoxical embolism: An en bloc approach to prevent clot embolism and facilitate repair.

Klompas, Allan M / Greason, Kevin / Click, Roger L / Mauermann, William J

Annals of cardiac anaesthesia

2021 Volume 24, Issue 4, Page(s) 476–478

Abstract: Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic ... ...

Abstract	Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g., heparin), systemic thrombolysis, or surgical thrombectomy. We present a case of IPE diagnosed with intraoperative transesophageal echocardiography (TEE) as well as a novel en bloc approach to atrial septal aneurysmectomy to minimize embolism and facilitate repair of the interatrial septum. Timely use of intraoperative TEE may aid in diagnosis and help guide the surgical approach to minimize embolic risk with an IPE.
MeSH term(s)	Echocardiography, Transesophageal ; Embolism, Paradoxical/diagnostic imaging ; Embolism, Paradoxical/prevention & control ; Embolism, Paradoxical/surgery ; Foramen Ovale, Patent/complications ; Foramen Ovale, Patent/diagnostic imaging ; Foramen Ovale, Patent/surgery ; Heart Septal Defects, Atrial/complications ; Heart Septal Defects, Atrial/diagnostic imaging ; Heart Septal Defects, Atrial/surgery ; Humans ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/prevention & control ; Thrombosis
Language	English
Publishing date	2021-11-08
Publishing country	India
Document type	Case Reports
ZDB-ID	2106866-5
ISSN	0974-5181 ; 0971-9784
ISSN (online)	0974-5181
ISSN	0971-9784
DOI	10.4103/aca.ACA_186_20
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Article ; Online: Analysis of Anemia, Transfusions, and CABG Outcomes in The Society of Thoracic Surgeons National Database.

Hosseini, Motahar / Griffeth, Elaine M / Schaff, Hartzell V / Klompas, Allan M / Warner, Matthew A / Stulak, John M / Dearani, Joseph A / Lee, Alexander T / Lahr, Brian D / Crestanello, Juan A

The Annals of thoracic surgery

2024 Volume 117, Issue 5, Page(s) 1053–1060

Abstract: Background: This study characterized the association of preoperative anemia and intraoperative red blood cell (RBC) transfusion on outcomes of elective coronary artery bypass grafting (CABG).: Methods: Data from 53,856 patients who underwent CABG ... ...

Abstract	Background: This study characterized the association of preoperative anemia and intraoperative red blood cell (RBC) transfusion on outcomes of elective coronary artery bypass grafting (CABG). Methods: Data from 53,856 patients who underwent CABG included in The Society of Thoracic Surgeons (STS) Adult Cardiac Database in 2019 were used. The primary outcome was operative mortality. Secondary outcomes were postoperative complications. The association of anemia with outcomes was analyzed with multivariable regression models. The influence of intraoperative RBC transfusion on the effect of preoperative anemia on outcomes was studied using mediation analysis. Results: Anemia was present in 25% of patients. Anemic patients had a higher STS Predicted Risk of Operative Mortality (1.2% vs 0.7%; P < .001). Anemia was associated with operative mortality (odds ratio [OR], 1.27; 99.5% CI, 1.00-1.61; P = .047), postoperative RBC transfusion (OR, 2.28; 99.5% CI, 2.12-2.44; P < .001), dialysis (OR, 1.58; 99.5% CI, 1.19-2.11; P < .001), and prolonged intensive care unit and hospital length of stay. Intraoperative RBC transfusion largely mediated the effects of anemia on mortality (76%), intensive care unit stay (99%), and hospital stay, but it only partially mediated the association with dialysis (34.9%). Conclusions: Preoperative anemia is common in patients who undergo CABG and is associated with increased postoperative risks of mortality, complications, and RBC transfusion. However, most of the effect of anemia on mortality is mediated through intraoperative RBC transfusion.
MeSH term(s)	Humans ; Male ; Female ; Anemia/epidemiology ; Anemia/complications ; Coronary Artery Bypass/adverse effects ; Aged ; Middle Aged ; Databases, Factual ; Erythrocyte Transfusion/statistics & numerical data ; Postoperative Complications/epidemiology ; Societies, Medical ; United States/epidemiology ; Retrospective Studies ; Thoracic Surgery ; Treatment Outcome ; Coronary Artery Disease/surgery ; Coronary Artery Disease/mortality ; Coronary Artery Disease/complications
Language	English
Publishing date	2024-01-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2024.01.009
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Zs.A 252: Show issues

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Article ; Online: Cold platelet transfusion: The effects of a fluid warmer on platelet function.

Valencia Morales, Diana J / Klompas, Allan M / Torbenson, Jenna M / Finney, Robyn E / Chen, Dong / Stubbs, James R / Nuttall, Gregory A

Transfusion

2023 Volume 64, Issue 1, Page(s) 47–52

Abstract: Background: Recently the US Food and Drug Administration has granted variances to select blood centers to supply cold-stored platelet components (CSP). In hemorrhage resuscitation warming of blood components with approved fluid warming devices is common. ...

Abstract	Background: Recently the US Food and Drug Administration has granted variances to select blood centers to supply cold-stored platelet components (CSP). In hemorrhage resuscitation warming of blood components with approved fluid warming devices is common. Study design and methods: Pathogen-reduced apheresis platelet units were collected and stored in one of two ways: (1) CSP-I, (2) CSP-D. CSP-I were collected and immediately stored at 1-6°C until used. CSP-D were collected and stored at 20-24°C for 5 days and transferred to storage at 1-6°C until use. Aggregometry using arachidonic acid (AA), adenosine diphosphate (ADP) and collagen as agonists was performed on the unit samples before and after the units were infused through a Ranger blood-warming device. Results: CSP-I, 23 units, had very high aggregation responses to all agonists (all ≥47.6 ± 20.7). There was a statistically significant reduction in ADP-induced aggregometry results from 55.1 ± 23.2 before compared to 33.5 ± 14.6 following infusion of the PLT through the blood warmer (p < .001). There were no differences in AA and collagen aggregometry results before and after the infusion of the platelets through the blood warmer. CSP-D had 5 of the 15 units with visible clotting in the bag. The 10 CSP-Ds studied had lower aggregation than all agonists before and after infusion through the blood-warming device (all ≤49.9 ± 35.9). Conclusion: We detected a statistically significant reduction in ADP-induced aggregometry in CSP-I run through a Ranger blood-warming device with no change with AA or collagen agonist aggregometry.
MeSH term(s)	Humans ; Platelet Transfusion/methods ; Platelet Aggregation ; Blood Platelets ; Collagen/pharmacology ; Adenosine Diphosphate/pharmacology ; Blood Preservation/methods ; Cold Temperature
Chemical Substances	Collagen (9007-34-5) ; Adenosine Diphosphate (61D2G4IYVH)
Language	English
Publishing date	2023-12-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.17624
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