Clinical Applications

Clinical Applications

Clinical Need

Hospitals are actively seeking to reduce their use of blood products and are in need of tools to guide more targeted transfusion practices.

Critical Bleeding and
the Risk of Transfusion

Critical bleeding is an issue in major surgeries, organ transplants, trauma and postpartum hemorrhage. In cardiac surgery, post-surgical bleeding occurs in up to 20% of cases.

Critical bleeding is common in major surgery, organ transplant and trauma throughout the hospital. Post-partum hemorrhage is the leading cause of maternal mortality world-wide. Point-of-care viscoelastic testing can be helpful for assessing the causes of coagulopathic bleeding and for guiding therapeutic intervention for perioperative bleeding management.

Bleeding can result from the depletion of coagulation factors, platelets or fibrinogen, hyperfibrinolysis, the presence of residual anticoagulants, or some combination of these factors. Each cause has a specific treatment option, the use of which can restore hemostasis. However, the transfusion of blood products increases the risk of infection, morbidity and length of stay. Determining when blood products are needed, which product is appropriate and how much to give is a major challenge for clinicians. Optimizing bleeding management with strategies that include point-of-care testing has been shown to improve patient outcomes and reduce the costs of perioperative bleeding complications.

clinical applications for quantra

 

Sample procedures in which critical bleeding can occur:

 

Cardiac Surgery

Trauma

Neurosurgery

Childbirth

Orthopedic Surgery

Organ Transplant

 

Need for Rapid, Comprehensive, Accurate Information to Guide Treatment

Current hemostatic tests provide only a subset of needed information, or take too long to be useful in critical bleeding situations, forcing clinicians to use iterative transfusion protocols that do not account for the patient’s actual coagulation status. This approach leads to over-transfusion and transfusion of inappropriate products. Up to 60% of red blood cell (RBC) transfusions lack clinical justification. Further, blood products are costly, making up about 1-2% of a hospital’s budget. Hospitals around the world are thus seeking ways to reduce their transfusion rates to improve outcomes and reduce costs.

Guidelines Support Need for POC Testing

The 2013 Practice Guidelines for Perioperative Blood Management Issued by the American Association for Anesthesiology Task Force indicated ” If coagulopathy is suspected, obtain viscoelastic assays …, when available, as well as platelet count”. Further, the 2016 Update to the European Society of Anaesthesiology Guidelines on the Management of severe perioperative bleeding recommended “the application of intervention algorithms incorporating pre-defined triggers and targets based on viscoelastic haemostatic (VHA) coagulation monitoring to guide individualised haemostatic intervention in the case of perioperative bleeding”.

Guidelines calling for POC viscoelastic testing published by major medical societies:

  • European Society of Anesthesiology
  • American Society of Anesthesiologists
  • Society of Cardiovascular Anesthesia
  • Society of Thoracic Surgeons

View Publications


References

Weber CF et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012 Sep;117(3):531-47.

Seicean et al. The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery. J Clin Neurosci.2014;21:1579-85.

Hajjar LA, Vincent JL, Galas FR, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010; 304:1559–67.

Koch CG et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg. 2006 May;81(5):1650-7.

Orlov et al. Platelet Dysfunction as Measured by a Point-of-Care Monitor is an Independent Predictor of High Blood Loss in Cardiac Surgery. Anesth Analg. 2014;118:257–63.

Shander A, Fink A, Javidroozi M, Erhard J, et al. Appropriateness of allogeneic red blood cell transfusion: the international consensus conference on transfusion outcomes. Transfus Med Rev. 2011 Jul;25(3):232-246.

Karkouti, K; McCluskey, SA; Callum, J; et al. Evaluation of a novel transfusion algorithm employing point-of-care coagulation assays in cardiac surgery: a retrospective cohort study with interrupted time-series analysis. Anesthesiology. 2015 Mar; 122(3):560-570.

Pearse, BL; Smith, I; Faulke, D; et al. (2015) Protocol guided bleeding management improves cardiac surgery patient outcomes. Vox Sanguinis doi:10.1111/vox.12279

Collins P, Abdul-Kadir R, Thachil J. Management of coagulopathy associated with postpartum hemorrhage: guidance from the SSC of the ISTH. J Thrombosis and Haemostasis. 2016; 14: 205-210.

Ballantyne A, Walmsley P, Brenkel I. Reduction of blood transfusion rates in unilateral total knee arthroplasty by the introduction of a simple blood transfusion protocol. Knee. 2003; 10:379–384.

Helm AT, Karski MT, Parsons SJ, Sampath JS, Bale RS. A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery. Audit of an algorithm for arthroplasty of the lower limb. J Bone Joint Surg Br. 2003; 85:484–489.

Slappendel R, Dirksen R, Weber EW, van der Schaaf DB. An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery. Acta Orthop Scand. 2003; 74:569–575

Rolston JD, Han SJ, Lau CY, Berger MS, Parsa AT. Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011. J Neurosurg. 2014;120(3):736–745

Gando S, Hayakawa M. Pathophysiology of trauma-induced coagulopathy and management of critical bleeding requiring massive transfusion. Semin Thromb Hemost. 2016;42(2): 155–165

Stein P, Kaserer A, Spahn GH, Spahn DR. Point-of-Care Coagulation Monitoring in Trauma Patients. Semin Thromb Hemost. 2017;43:367-374.

Cleland S, Corredor C, Ye JJ, Srinivas C, McCluskey SA. Massive haemorrhage in liver transplantation: Consequences, prediction and mangement. World J Transplantation. 2016;6(2):291-305.

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