Perioperative haemostasis and coagulation management in cardiac surgery

Background and objectives: During the last decade many aspects of haemostasis and coagulation management greatly changed in cardiac surgery. On one side, new anti-platelet agents entered the market and became more and more widely used; on the other one, point-of-care monitoring tools are nowadays available for perioperative use. The present survey is aimed to investigate the perioperative haemostasis and coagulation management in European Cardiac Surgery Institutions. Methods: A questionnaire exploring different aspects of perioperative haemostasis and coagulation management was sent to 320 Cardiac Surgery Institutions in Europe. Results: 82 Institutions replied to the survey. Due to the poor quality of the data collection, 9 Institutions were excluded. A pool of 73 questionnaires coming from 24 different Countries was analyzed. Non-routine coagulation tests (antithrombin activity) are done in 34% of the Institutions before the operation and in 23% after the operation. Point-of-care tests are applied as a preoperative routine in 9.9% of the Institutions (thromboelastography, 5.7%; PFA-100, 1.4%; others, 2.8%) and in selected patients in 50% of the Institutions. Postoperative point-of-care test are applied in 17.9% of the Institutions (thromboelastography, 2.7%; PFA-100, 1.4%; others, 13.8%). Allogeneic blood products use widely differs among Institution: packed red cells are used in 47.5% of the patients (range 8%-90%), fresh frozen plasma in 29% (2%-100%) and platelets in 12.4% (0%-50%). Conclusions: Perioperative haemostasis and coagulation management is widely different among European Institutions. Point-of-care coagulation and platelet function tests are gaining a significant role. Transfusional policy appears strongly Institution-dependent.