Scholars@Duke
Ian James Welsby

Ian James Welsby

Professor of Anesthesiology
Anesthesiology, Cardiothoracic
ian.welsby@duke.edu
Box 3094 Med Ctr, Durham, NC 27710
2301 Erwin Road, 5691H Hafs Building, Durham, NC 27710

Selected Publications

Thrombin generation after prothrombin complex concentrate or plasma transfusion during cardiac surgery.

Journal Article J Thromb Thrombolysis · December 4, 2024 Thrombin generation (TG) is reduced after cardiac surgery using cardiopulmonary bypass (CPB), contributing to coagulopathy and bleeding. Plasma transfusion or four-factor prothrombin complex concentrate (PCC) are commonly used to treat coagulopathic bleedi ... Full text Link to item Cite

Management of Central Airway Obstruction: An American College of Chest Physicians Clinical Practice Guideline.

Journal Article Chest · July 18, 2024 BACKGROUND: Central airway obstruction (CAO), seen in a variety of malignant and nonmalignant airway disorders, is associated with a poor prognosis. The management of CAO is dependent on provider training and local resources, which may make the clinical ap ... Full text Link to item Cite

Oxidative Stress and Cerebral Vascular Tone: The Role of Reactive Oxygen and Nitrogen Species.

Journal Article Int J Mol Sci · March 5, 2024 The brain's unique characteristics make it exceptionally susceptible to oxidative stress, which arises from an imbalance between reactive oxygen species (ROS) production, reactive nitrogen species (RNS) production, and antioxidant defense mechanisms. This ... Full text Link to item Cite

Characterization of an andexanet alfa administration protocol guided by drug-specific quantitative anti-Xa assays.

Journal Article J Thromb Thrombolysis · February 2024 Following FDA approval in 2018, consensus guidelines recommend andexanet alfa as first-line therapy for the management of life-threatening or uncontrollable bleeding in patients taking oral factor Xa (FXa) inhibitors. Dosing is based on the specific FXa in ... Full text Link to item Cite

Modulation of the allosteric and vasoregulatory arms of erythrocytic oxygen transport.

Journal Article Front Physiol · 2024 Efficient distribution of oxygen (O2) to the tissues in mammals depends on the evolved ability of red blood cell (RBC) hemoglobin (Hb) to sense not only O2 levels, but metabolic cues such as pH, PCO2, and organic phosphates, and then dispense or take up ox ... Full text Link to item Cite

Evaluation of the efficacy and safety of amustaline/glutathione pathogen-reduced RBCs in complex cardiac surgery: the Red Cell Pathogen Inactivation (ReCePI) study-protocol for a phase 3, randomized, controlled trial.

Journal Article Trials · December 11, 2023 BACKGROUND: Red blood cell (RBC) transfusion is a critical supportive therapy in cardiovascular surgery (CVS). Donor selection and testing have reduced the risk of transfusion-transmitted infections; however, risks remain from bacteria, emerging viruses, p ... Full text Link to item Cite

Inhaled Epoprostenol Compared With Nitric Oxide for Right Ventricular Support After Major Cardiac Surgery.

Journal Article Circulation · October 24, 2023 BACKGROUND: Right ventricular failure (RVF) is a leading driver of morbidity and death after major cardiac surgery for advanced heart failure, including orthotopic heart transplantation and left ventricular assist device implantation. Inhaled pulmonary-sel ... Full text Open Access Link to item Cite

Clinical Relevance of Preclinical and Clinical Studies of Four-Factor Prothrombin Complex Concentrate for Treatment of Bleeding Related to Direct Oral Anticoagulants.

Journal Article Ann Emerg Med · September 2023 Direct oral anticoagulants (DOACs) are widely used for the prevention and treatment of venous thromboembolism and stroke. When emergency reversal of DOAC-related anticoagulation is required, specific DOAC reversal agents are recommended, including idaruciz ... Full text Link to item Cite

Development of New Donor-Specific and Human Leukocyte Antigen Antibodies After Transfusion in Adult Lung Transplantation.

Journal Article J Cardiothorac Vasc Anesth · September 2023 OBJECTIVES: The development of new human leukocyte antigens (HLAs) and donor-specific antibodies (DSAs) in patients are associated with worse outcomes following lung transplantation. The authors aimed to examine the relationship between blood product trans ... Full text Open Access Link to item Cite

Voxelotor as a Treatment of Persistent Hypoxia in the ICU.

Journal Article Chest · July 2023 Hypoxia is encountered frequently in the ICU as a result of a wide range of pathologic characteristics. The oxygen-hemoglobin dissociation curve describes hemoglobin's affinity for a given Po2 and factors affecting uptake and offload. Research i ... Full text Cite

Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors.

Journal Article Circulation · March 28, 2023 BACKGROUND: Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, ... Full text Link to item Cite

Incidence of Postreperfusion Hyperfibrinolysis in Liver Transplantation by Donor Type and Observed Treatment Strategies.

Journal Article Anesth Analg · March 1, 2023 BACKGROUND: Hyperfibrinolysis is a possible complication during liver transplantation, particularly immediately after reperfusion. METHODS: We performed a retrospective study to examine the incidence, treatment, and resolution of postreperfusion hyperfibri ... Full text Open Access Link to item Cite

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Preoperative Antithrombin Supplementation in Patients at Risk for Antithrombin Deficiency After Cardiac Surgery.

Journal Article Anesth Analg · October 1, 2022 BACKGROUND: Antithrombin (AT) activity is reduced during cardiac operations with cardiopulmonary bypass (CPB), which is associated with adverse outcomes. Preoperative AT supplementation, to achieve >58% and <100% AT activity, may potentially reduce postope ... Full text Link to item Cite

Prothrombin Complex Concentrate vs Plasma for Post-Cardiopulmonary Bypass Coagulopathy and Bleeding: A Randomized Clinical Trial.

Journal Article JAMA Surg · September 1, 2022 Featured Publication IMPORTANCE: Post-cardiopulmonary bypass (CPB) coagulopathy and bleeding are among the most common reasons for blood product transfusion in surgical practices. Current retrospective data suggest lower transfusion rates and blood loss in patients receiving p ... Full text Link to item Cite

Heated Humidified Breathing Circuit Rewarming in Hypothermic Patients Post-Cardiopulmonary Bypass-Pilot Study.

Journal Article J Cardiothorac Vasc Anesth · April 2022 OBJECTIVES: Hypothermia on intensive care unit (ICU) admission after cardiac surgery and cardiopulmonary bypass is common. It contributes to postoperative complications including shivering, coagulopathy, increased blood loss and transfusion requirements, m ... Full text Link to item Cite

Andexanet alfa and four-factor prothrombin complex concentrate for reversal of apixaban and rivaroxaban in patients diagnosed with intracranial hemorrhage.

Journal Article Journal of thrombosis and thrombolysis · January 2022 Limited data exists regarding the clinical outcomes of andexanet alfa and four factor prothrombin complex concentrate (4F-PCC) for reversal of apixaban or rivaroxaban in the setting of intracranial hemorrhage (ICH). The objective of this study was to evalu ... Full text Cite

Management of Perioperative Iron Deficiency in Cardiac Surgery: A Modified RAND Delphi Study.

Journal Article Ann Thorac Surg · January 2022 BACKGROUND: Over the last decade, preoperative anemia has become recognized as a clinical condition in need of management. Although the etiology of preoperative anemia can be multifactorial, two thirds of anemic elective surgical patients have iron deficie ... Full text Link to item Cite

What Drugs Decrease Perioperative Bleeding?

Chapter · January 1, 2022 Perioperative bleeding can lead to increased patient morbidity and mortality. Patients should be assessed for anemia preope­ratively and optimized before elective surgery. Management of intraoperative bleeding should be guided by point-of-care, test-driven ... Full text Cite

Optimizing management of sickle cell disease in patients undergoing surgery.

Journal Article Hematology Am Soc Hematol Educ Program · December 10, 2021 Individuals with sickle cell disease (SCD) are likely to be referred for surgery at some point in their lifetime due to a high incidence of musculoskeletal and intrabdominal complications such as avascular necrosis and gallbladder disease. Preoperative opt ... Full text Link to item Cite

Activated Coagulation Time and Hepcon Protamine Titration Device to Manage Unfractionated Heparin During Cardiopulmonary Bypass in a Hemophilia A Patient on Emicizumab.

Journal Article J Cardiothorac Vasc Anesth · November 2021 In the perioperative management of patients with hemophilia A, emicizumab prevents the accurate measurement of common clotting assays, including the activated clotting time (ACT), which is essential for high-dose heparin monitoring during cardiopulmonary b ... Full text Open Access Link to item Cite

Blood product transfusion and lung transplant outcomes: A systematic review.

Journal Article Clinical transplantation · October 2021 The perioperative transfusion of blood products has long been linked to development of acute lung injury and associated with mortality across both medical and surgical patient populations.1,2 The need for blood product transfusion during and aft ... Full text Cite

Fatty acid desaturase activity in mature red blood cells and implications for blood storage quality.

Journal Article Transfusion · June 2021 BACKGROUND: Increases in the red blood cell (RBC) degree of fatty acid desaturation are reported in response to exercise, aging, or diseases associated with systemic oxidant stress. However, no studies have focused on the presence and activity of fatty aci ... Full text Link to item Cite

Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury.

Journal Article J Cardiothorac Vasc Anesth · May 2021 OBJECTIVE: Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) serves to hemoconcentrate blood volume to avoid allogeneic blood transfusions. Previous studies have determined CUF volumes as a continuous variable are associated with posto ... Full text Open Access Link to item Cite

The ARREST Pneumonia Clinical Trial. Rationale and Design.

Journal Article Ann Am Thorac Soc · April 2021 Patients hospitalized for pneumonia are at high risk for mortality. Effective therapies are therefore needed. Recent randomized clinical trials suggest that systemic steroids can reduce the length of hospital stays among patients hospitalized for pneumonia ... Full text Link to item Cite

Global sources of cryoprecipitate demonstrate variability in coagulant factor levels and functional hemostasis.

Journal Article Blood Coagul Fibrinolysis · March 1, 2021 Cryoprecipitate (cryo) is a plasma-derived blood product utilized during trauma resuscitation, surgery, and other major bleeding. Although local quality control metrics exist, inherent donor variability, and processing may confer differences in hemostatic ... Full text Link to item Cite

Modulation of red blood cell oxygen affinity with a novel allosteric modifier of hemoglobin is additive to the Bohr effect.

Journal Article Blood Cells Mol Dis · March 2021 PURPOSE: The Bohr effect describes hemoglobin's affinity for oxygen dependent on solution pH. Within pH range 6.0-8.5, hemoglobin's oxygen affinity decreases with decreasing pH. This results in increased oxygen delivery to metabolically active, acidic tiss ... Full text Link to item Cite

Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove Cytokines, Chemokines, and Cell-derived Microvesicles.

Journal Article Anesthesiology · March 1, 2021 BACKGROUND: Removal of cytokines, chemokines, and microvesicles from the supernatant of allogeneic erythrocytes may help mitigate adverse transfusion reactions. Blood bank-based washing procedures present logistical difficulties; therefore, we tested the h ... Full text Link to item Cite

Clinical outcomes of cardiac surgery patients undergoing therapeutic plasma exchange for heparin-induced thrombocytopenia.

Journal Article Vox Sang · February 2021 BACKGROUND AND OBJECTIVES: Heparin-induced thrombocytopenia (HIT) is an antibody-mediated condition that leads to thrombocytopenia and possible thrombosis. Patients with HIT who require cardiac surgery pose a challenge as high doses of heparin or heparin a ... Full text Open Access Link to item Cite

Prevention and Management of Deep Vein Thrombosis and Pulmonary Embolism

Chapter · January 1, 2021 Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common, preventable perioperative complication occurring in up to 5% on noncardiac surgical patients. Even when treated, DVT can lead to long-term consequences, ... Full text Cite

COVID-19 associated coagulopathy: Thrombosis, hemorrhage and mortality rates with an escalated-dose thromboprophylaxis strategy.

Journal Article Thromb Res · December 2020 • COVID-19 patients are at increased risk of thromboembolic complications. • Escalated-dose thromboprophylaxis may help reduce the rate of thromboembolic events. • The bleeding risk is highest for patients treated with therapeutic anticoagulation. ... Full text Link to item Cite

COVID-19 Associated Coagulopathy: Thrombosis, Hemorrhage and Mortality Rates with an Escalated-Thromboprophylaxis Strategy

Conference Blood · November 5, 2020 Introduction: Early studies identified a prothrombotic state associated with novel coronavirus disease 2019 (COVID-19) as well as a survival benefit observed with heparin use in severely ill COVID-19 patients. There is a need to clarify the inciden ... Full text Cite

The effect of pathogen inactivation on cryoprecipitate: a functional and quantitative evaluation.

Journal Article Blood Transfus · November 2020 BACKGROUND: As a pooled donor blood product, cryoprecipitate (cryo) carries risks of pathogen transmission. Pathogen inactivation (PI) improves the safety of cryoprecipitate, but its effects on haemostatic properties remain unclear. This study investigated ... Full text Link to item Cite

Anticoagulation Strategies in the Perioperative Period for Lung Transplant.

Journal Article Ann Thorac Surg · July 2020 Patients who are undergoing lung transplantation may require systemic anticoagulation in the perioperative period for various indications at the time of the procedure. Four-factor prothrombin complex concentrate has been approved in the United States to re ... Full text Link to item Cite

Rejuvenation solution as an adjunct cold storage solution maintains physiological haemoglobin oxygen affinity during early-storage period of red blood cells.

Journal Article Vox Sang · July 2020 BACKGROUND: Red blood cell (RBC) units accumulate morphologic and metabolic lesions during storage before transfusion. Pyruvate-inosine-phosphate-adenine (PIPA) solutions (Rejuvesol, Biomet, Warsaw, IN) can be incubated with RBC units to mitigate storage l ... Full text Link to item Cite

Effects of repleting organic phosphates in banked erythrocytes on plasma metabolites and vasoactive mediators after red cell exchange transfusion in sickle cell disease.

Journal Article Blood Transfus · May 2020 BACKGROUND: Red blood cell (RBC) exchange (RCE) transfusion therapy is indicated for certain patients with sickle cell disease (SCD). Although beneficial, this therapy is costly and inconvenient to patients, who may require it monthly or more often. Identi ... Full text Link to item Cite

In Response.

Other Anesth Analg · May 2020 Full text Link to item Cite

Intrapulmonary Activated Factor VII for Hemoptysis Complicating Pulmonary Thromboendarterectomy.

Journal Article Ann Thorac Surg · April 2020 Massive hemoptysis represents a life-threatening disorder that has numerous different causes. The development of recombinant factor concentrates has allowed for novel treatments in this emergency setting. This report describes a patient with chronic thromb ... Full text Link to item Cite

ABO Blood Group and Transfusions In the Intraoperative and Postoperative Period After LVAD Implantation.

Journal Article J Cardiothorac Vasc Anesth · April 2020 OBJECTIVES: To assess whether blood group O patients undergoing left ventricular assist device (LVAD) insertion have higher perioperative transfusion requirements, postoperative chest tube output, and postoperative changes in hematocrit. DESIGN: Retrospect ... Full text Link to item Cite

Multicenter Evaluation of the Quantra QPlus System in Adult Patients Undergoing Major Surgical Procedures.

Journal Article Anesth Analg · April 2020 BACKGROUND: The management of perioperative bleeding and the optimization of the available therapies are subjects of significant clinical interest. Clinical guidelines recommend the use of whole blood viscoelastic testing devices to target the utilization ... Full text Link to item Cite

Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation

Conference The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · April 1, 2020 PURPOSE: Transfusion during lung transplantation (LT) is linked to primary graft dysfunction (PGD) and worsened outcomes. Goal-directed protocols have improved outcomes in cardiac surgical populations and decreased transfusions in LT on cardiopulmonary byp ... Full text Cite

Red blood cell microvesicles activate the contact system, leading to factor IX activation via 2 independent pathways.

Journal Article Blood · March 5, 2020 Storage lesion-induced, red cell-derived microvesicles (RBC-MVs) propagate coagulation by supporting the assembly of the prothrombinase complex. It has also been reported that RBC-MVs initiate coagulation via the intrinsic pathway. To elucidate the mechani ... Full text Link to item Cite

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients.

Journal Article J Cardiothorac Vasc Anesth · November 2019 Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient bl ... Full text Link to item Cite

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients.

Journal Article Anesth Analg · November 2019 Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient bl ... Full text Link to item Cite

Metabolic impact of red blood cell exchange with rejuvenated red blood cells in sickle cell patients.

Journal Article Transfusion · October 2019 BACKGROUND: Red blood cell exchange (RCE) transfusions are a mainstay in the treatment of sickle cell anemia (SCA), and allow a temporary restoration of physiological parameters with respect to erythrocyte oxygen carrying capacity and systems metabolism. R ... Full text Link to item Cite

Interval decline in hemoglobin A is associated with annual clinical event rate in sickle cell anemia patients receiving maintenance apheresis RBC exchange.

Journal Article Transfusion · August 2019 BACKGROUND: Apheresis red blood cell (RBC) exchange (RCE) is a standard intervention for patients with sickle cell anemia (SCA) who have had previous thromboembolic stroke or intractable chronic pain. Replacing sickling cells with those containing hemoglob ... Full text Link to item Cite

Three-factor prothrombin complex concentrates for refractory bleeding after cardiovascular surgery within an algorithmic approach to haemostasis.

Journal Article Vox Sang · May 2019 BACKGROUND/OBJECTIVES: Prothrombin complex concentrates (PCC) are increasingly administered off-label in the United States to treat bleeding in cardiovascular surgical patients and carry the potential risk for acquired thromboembolic side-effects after sur ... Full text Open Access Link to item Cite

Effects of red blood cell (RBC) transfusion on sickle cell disease recipient plasma and RBC metabolism.

Journal Article Transfusion · December 2018 BACKGROUND: Exchange transfusion is a mainstay in the treatment of sickle cell anemia. Transfusion recipients with sickle cell disease (SCD) can be transfused over 10 units per therapy, an intervention that replaces circulating sickle red blood cells (RBCs ... Full text Link to item Cite

Cangrelor use prior to left ventricular assist device surgery: a case series.

Journal Article J Thromb Thrombolysis · August 2018 Bleeding frequently occurs in patients undergoing placement of a left ventricular assist device (LVAD). Clinical factors that have been identified as contributing to peri-procedural bleeding include LVAD implantation after an acute myocardial infarction an ... Full text Link to item Cite

Metabolomics evaluation of early-storage red blood cell rejuvenation at 4°C and 37°C.

Journal Article Transfusion · August 2018 BACKGROUND: Refrigerated red blood cell (RBC) storage results in the progressive accumulation of biochemical and morphological alterations collectively referred to as the storage lesion. Storage-induced metabolic alterations can be in part reversed by reju ... Full text Link to item Cite

Differentiating between cold agglutinins and rouleaux: a case series of seven patients.

Journal Article Perfusion · March 2018 We present a case series of seven patients with suspected cold agglutinin antibodies, discovered after initiation of bypass. Laboratory analysis of blood samples intraoperatively determined the cause of the aggregation to be rouleaux formation in three of ... Full text Link to item Cite

Intraoperative Administration of 4-Factor Prothrombin Complex Concentrate Reduces Blood Requirements in Cardiac Transplantation.

Journal Article J Cardiothorac Vasc Anesth · February 2018 OBJECTIVE: Assessing the efficacy of intraoperative 4-factor prothrombin complex concentrate (4F-PCC) use in blood product utilization, time to chest closure, intensive care unit (ICU) and hospital length of stay (LOS), thromboembolic complications, renal ... Full text Link to item Cite

Epsilon Aminocaproic Acid to Reduce Blood Loss and Transfusion After Total Hip and Total Knee Arthroplasty.

Journal Article J Arthroplasty · January 2018 BACKGROUND: Total hip and knee arthroplasty (THA and TKA) are associated with significant blood loss and some patients require postoperative blood transfusion. While tranexamic acid has been studied extensively among this population, we tested the hypothes ... Full text Link to item Cite

Estimation of Achievable Oxygen Consumption Following Transfusion With Rejuvenated Red Blood Cells.

Journal Article Semin Thorac Cardiovasc Surg · 2018 Erythrocyte storage induces a nonphysiological increase in hemoglobin-oxygen affinity (quantified by low p50, the oxygen tension at 50% hemoglobin saturation), which can be restored through biochemical rejuvenation. The objective was to mathematically mode ... Full text Link to item Cite

Blood and coagulation

Chapter · January 1, 2018 Hemostasis is a critical homeostatic mechanism of survival that involves vascular, cellular, and plasma components that interact to stop bleeding. Vascular effects include vasoconstriction, expression of procoagulant factors such as tissue factor, and loss ... Full text Cite

Adjuncts to Blood Component Therapies for the Treatment of Bleeding in the Intensive Care Unit.

Journal Article Transfus Med Rev · October 2017 Patients who are critically ill following surgical or traumatic injury often present with coagulopathy as a component of the complex multisystem dysfunction that clinicians must rapidly diagnose and treat in the intensive care environment. Failure to recog ... Full text Link to item Cite

Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.

Journal Article Anesth Analg · October 2017 BACKGROUND: Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated w ... Full text Open Access Link to item Cite

Point-of-care washing of allogeneic red blood cells for the prevention of transfusion-related respiratory complications (WAR-PRC): a protocol for a multicenter randomised clinical trial in patients undergoing cardiac surgery.

Journal Article BMJ Open · August 18, 2017 Featured Publication INTRODUCTION: The transfusion-related respiratory complications, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are leading causes of transfusion-related morbidity and mortality. At present, there are ... Full text Link to item Cite

Adult extracorporeal membrane oxygenation: an international survey of transfusion and anticoagulation techniques.

Journal Article Vox Sang · July 2017 BACKGROUND AND OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is a method of life support for either isolated cardiac failure or respiratory failure, with or without cardiac failure. When used for hemodynamic support, the ECMO circuit presents a no ... Full text Link to item Cite

Should modulation of p50 be a therapeutic target in the critically ill?

Journal Article Expert Rev Hematol · May 2017 A defining feature of human hemoglobin is its oxygen binding affinity, quantified by the partial pressure of oxygen at which hemoglobin is 50% saturated (p50), and the variability of this parameter over a range of physiological and environmental states. Mo ... Full text Link to item Cite

Bleeding risk associated with eptifibatide (Integrilin) bridging in thoracic surgery patients.

Journal Article J Thromb Thrombolysis · February 2017 Antiplatelet use for treatment of coronary artery disease (CAD) is common amongst thoracic surgery patients. Perioperative management of antiplatelet agents requires balancing the opposing risks of myocardial ischemia and excessive bleeding. Perioperative ... Full text Link to item Cite

The association of anti-platelet factor 4/heparin antibodies with early and delayed thromboembolism after cardiac surgery.

Journal Article J Thromb Haemost · January 2017 UNLABELLED: Essentials We evaluated antibody status, thromboembolism and survival after cardiac surgery. Positive antibody tests are common - over 50% are seropositive at 30 days. Seropositivity did not increase thromboembolism or impair survival after car ... Full text Link to item Cite

Using antifibrinolytics in the peripartum period - concern for a hypercoagulable effect?

Journal Article J Neonatal Perinatal Med · 2017 INTRODUCTION: Although antifibrinolytic agents are used to prevent and treat hemorrhage, there are concerns about a potential increased risk for peripartum venous thromboembolism. We sought to determine the impact of tranexamic acid and ɛ-aminocaproic acid ... Full text Open Access Link to item Cite

Does moderate hypothermia really carry less bleeding risk than deep hypothermia for circulatory arrest? A propensity-matched comparison in hemiarch replacement.

Journal Article J Thorac Cardiovasc Surg · December 2016 BACKGROUND: Moderate (MHCA) versus deep (DHCA) hypothermia for circulatory arrest in aortic arch surgery has been purported to reduce coagulopathy and bleeding complications, although there are limited data supporting this claim. This study aimed to compar ... Full text Link to item Cite

Perioperative management of the bleeding patient.

Journal Article Br J Anaesth · December 2016 Perioperative bleeding remains a major complication during and after surgery, resulting in increased morbidity and mortality. The principal causes of non-vascular sources of haemostatic perioperative bleeding are a preexisting undetected bleeding disorder, ... Full text Open Access Link to item Cite

Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial.

Journal Article Can J Anaesth · November 2016 PURPOSE: Postoperative cognitive dysfunction (POCD) occurs frequently after cardiac surgery. The pathophysiology of POCD remains elusive, but previous work showed that intravenous lidocaine may be protective against POCD, possibly by modulating cerebral in ... Full text Link to item Cite

Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors.

Journal Article N Engl J Med · September 22, 2016 BACKGROUND: Andexanet alfa (andexanet) is a recombinant modified human factor Xa decoy protein that has been shown to reverse the inhibition of factor Xa in healthy volunteers. METHODS: In this multicenter, prospective, open-label, single-group study, we e ... Full text Open Access Link to item Cite

In Reply.

Journal Article Anesthesiology · August 2016 Full text Link to item Cite

Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting.

Other Anesth Analg · May 2016 Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor co ... Full text Open Access Link to item Cite

Antithrombin: anti-inflammatory properties and clinical applications.

Other Thromb Haemost · April 2016 Many humoral and cellular components participate in bidirectional communication between the coagulation and inflammation pathways. Natural anticoagulant proteins, including antithrombin (AT), tissue factor pathway inhibitor, and protein C, suppress proinfl ... Full text Link to item Cite

Use of human fibrinogen concentrate during proximal aortic reconstruction with deep hypothermic circulatory arrest.

Journal Article J Thorac Cardiovasc Surg · February 2016 OBJECTIVE: Human fibrinogen concentrate (HFC) is approved by the Food and Drug Administration for use at 70 mg/kg to treat congenital afibrinogenemia. We sought to determine whether this dose of HFC increases fibrinogen levels in the setting of high-risk b ... Full text Link to item Cite

Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

Journal Article Anesthesiology · February 2016 BACKGROUND: Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperat ... Full text Open Access Link to item Cite

Prolonged postoperative respiratory support after proximal thoracic aortic surgery: Is deep hypothermic circulatory arrest a risk factor?

Journal Article J Crit Care · February 2016 PURPOSE: In addition to the pulmonary risks associated with cardiopulmonary bypass, thoracic aortic surgery using deep hypothermic circulatory arrest (DHCA) may subject the lungs to further injury. However, this topic has received little investigation to d ... Full text Link to item Cite

Andexanet alfa for the reversal of Factor Xa inhibitor related anticoagulation.

Other Expert Rev Hematol · 2016 Andexanet alfa is a specific reversal agent for Factor Xa inhibitors. The molecule is a recombinant protein analog of factor Xa that binds to Factor Xa inhibitors and antithrombin:LMWH complex but does not trigger prothrombotic activity. In ex vivo, animal ... Full text Open Access Link to item Cite

Perioperative Removal of Autologous Platelets.

Journal Article Ann Thorac Surg · November 2015 Full text Link to item Cite

Genome-wide association study of acute kidney injury after coronary bypass graft surgery identifies susceptibility loci.

Journal Article Kidney Int · October 2015 Acute kidney injury (AKI) is a common, serious complication of cardiac surgery. Since prior studies have supported a genetic basis for postoperative AKI, we conducted a genome-wide association study (GWAS) for AKI following coronary bypass graft (CABG) sur ... Full text Open Access Link to item Cite

Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study.

Journal Article J Crit Care · October 2015 BACKGROUND: Post-cardiac surgery pulmonary dysfunction may be underreported. Therefore, we evaluated associated risk factors for prolonged pulmonary support after cardiac surgery. METHODS AND MATERIALS: We conducted a retrospective, observational study of ... Full text Link to item Cite

Sickle cell disease is associated with iron mediated hypercoagulability.

Journal Article J Thromb Thrombolysis · August 2015 Sickle cell disease (SCD) is associated with a significant hypercoagulable state and several hemostatic anomalies have been identified in this disease state. Of interest, SCD patients can become iron overloaded after transfusion, and iron can enhance fibri ... Full text Link to item Cite

Bloodless Orthotopic Heart Transplantation in a Jehovah's Witness.

Journal Article A A Case Rep · May 15, 2015 We present the case of a 53-year-old female Jehovah's Witness with nonischemic cardiomyopathy who successfully underwent a bloodless heart transplantation using fibrinogen concentrate (RiaSTAP; CSL Behring, King of Prussia, PA) and other blood-conservation ... Full text Link to item Cite

Invited commentary.

Journal Article Ann Thorac Surg · March 2015 Full text Link to item Cite

Improved early survival with a nonsternotomy approach for continuous-flow left ventricular assist device replacement.

Journal Article Ann Thorac Surg · February 2015 BACKGROUND: Even in the modern era of continuous-flow left ventricular assist devices (CF LVADs), device replacement may be required. Nonsternotomy (NS) approaches are being used more commonly for replacement procedures. Outcomes after this less invasive a ... Full text Link to item Cite

Hyperbaric oxygen therapy for treatment of neurologic sequela after atrioesophageal fistula.

Journal Article Ann Thorac Surg · February 2015 Atrioesophageal fistula (AEF) is a rare complication after radiofrequency ablation for atrial fibrillation but is associated with high mortality, usually due to sepsis or neurologic injury. We report the case of a patient who presented with an AEF and dens ... Full text Link to item Cite

Split blood products

Chapter · January 1, 2015 The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV trans ... Full text Cite

ABO blood group influences transfusion and survival after cardiac surgery.

Journal Article J Thromb Thrombolysis · October 2014 ABO dependent variation in von Willebrand factor (vWf) and procoagulant factor VIII (FVIII) is a plausible mechanism for modulating perioperative hemostasis and bleeding. Group AB has the highest and group O the lowest vWf and FVIII levels. Therefore, we t ... Full text Link to item Cite

G protein-coupled receptor kinase 5 gene polymorphisms are associated with postoperative atrial fibrillation after coronary artery bypass grafting in patients receiving β-blockers.

Other Circ Cardiovasc Genet · October 2014 BACKGROUND: We hypothesized that genetic variations in the adrenergic signaling pathway and cytochrome P450 2D6 enzyme are associated with new-onset atrial fibrillation (AF) in patients who underwent coronary artery bypass grafting and were treated with pe ... Full text Link to item Cite

Is ABO blood group truly a risk factor for thrombosis and adverse outcomes?

Journal Article World J Cardiol · September 26, 2014 ABO blood type is one of the most readily available laboratory tests, and serves as a vital determinant in blood transfusion and organ transplantation. The ABO antigens are expressed not only on red blood cell membranes, determining the compatibility of tr ... Full text Link to item Cite

Using Zero Balance Ultrafiltration with Dialysate as a Replacement Fluid for Hyperkalemia during Cardiopulmonary Bypass.

Journal Article J Extra Corpor Technol · September 2014 Avoiding or managing hyperkalemia during cardiac surgery, especially in a patient with chronic renal insufficiency, can be challenging. Hyperkalemic cardioplegia solution is usually administered to achieve and maintain an electrical arrest of the heart. Th ... Link to item Cite

Arterial hyperoxia during cardiopulmonary bypass and postoperative cognitive dysfunction.

Journal Article J Cardiothorac Vasc Anesth · June 2014 OBJECTIVE: To determine the effect of arterial normobaric hyperoxia during cardiopulmonary bypass (CPB) on postoperative neurocognitive function. The authors hypothesized that arterial hyperoxia during CPB is associated with neurocognitive decline at 6 wee ... Full text Link to item Cite

Ventilation and anesthetic approaches for rigid bronchoscopy.

Journal Article Ann Am Thorac Soc · May 2014 Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate pat ... Full text Link to item Cite

Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy.

Other Transfusion · May 2014 Fibrinogen plays a critical role in achieving and maintaining hemostasis and is fundamental to effective clot formation. There is increasing awareness of the important role of fibrinogen as a key target for the treatment and prevention of acquired bleeding ... Full text Link to item Cite

Reduced use of allogeneic platelets through high-yield perioperative autologous plateletpheresis and reinfusion.

Journal Article Transfusion · May 2014 BACKGROUND: Intraoperative autologous platelet (PLT) collection as part of a multimodal blood conservation program carries a Class IIa recommendation from the Societies of Thoracic Surgeons and Cardiovascular Anesthesiologists, but achieving a suitable PLT ... Full text Link to item Cite

Extracorporeal membrane oxygenation in the adult: a review of anticoagulation monitoring and transfusion.

Journal Article Anesth Analg · April 2014 Extracorporeal membrane oxygenation (ECMO) is a method of life support to maintain cardiopulmonary function. Its use as a medical application has increased since its inception to treat multiple conditions including acute respiratory distress syndrome, myoc ... Full text Link to item Cite

Techniques and applications of perioperative therapeutic plasma exchange.

Journal Article Curr Opin Anaesthesiol · February 2014 PURPOSE OF REVIEW: Therapeutic plasma exchange (TPE) is a useful adjunct in the management of antibody-mediated disorders. The indications for TPE now include the perioperative setting. This review updates the anesthesiologist on the relevant clinical indi ... Full text Link to item Cite

High incidence of antibodies to protamine and protamine/heparin complexes in patients undergoing cardiopulmonary bypass.

Journal Article Blood · April 11, 2013 Protamine is routinely used to reverse heparin anticoagulation during cardiopulmonary bypass (CPB). Heparin interacts with protamine to form ultralarge complexes that are immunogenic in mice. We hypothesized that patients exposed to protamine and heparin d ... Full text Link to item Cite

Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.

Journal Article Heart Surg Forum · April 2013 OBJECTIVE: Oral P2Y₁₂ platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y₁₂ platelet receptor inhibitors before surgery. ... Full text Link to item Cite

Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.

Journal Article Ann Thorac Surg · June 2012 BACKGROUND: Numerous studies have supported the effectiveness of recombinant activated factor VII (rFVIIa) for the control of bleeding after cardiac procedures; however safety concerns persist. Here we report the novel use of intraoperative low-dose rFVIIa ... Full text Link to item Cite

The procoagulant properties of purified fibrinogen concentrate are enhanced by carbon monoxide releasing molecule-2.

Journal Article Thromb Res · June 2012 INTRODUCTION: Fibrinogen concentrate has been demonstrated to enhance coagulation in vitro and in several clinical settings of coagulopathy. We have recently demonstrated that carbon monoxide releasing molecule-2 (tricarbonyldichlororuthenium (II) dimer; C ... Full text Link to item Cite

Invited commentary.

Journal Article Ann Thorac Surg · March 2012 Full text Link to item Cite

Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial.

Journal Article JAMA · January 18, 2012 CONTEXT: Thienopyridines are among the most widely prescribed medications, but their use can be complicated by the unanticipated need for surgery. Despite increased risk of thrombosis, guidelines recommend discontinuing thienopyridines 5 to 7 days prior to ... Full text Link to item Cite

Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection.

Journal Article Ann Thorac Surg · December 2011 BACKGROUND: Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperati ... Full text Link to item Cite

Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery.

Journal Article Ann Thorac Surg · June 2011 BACKGROUND: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow gra ... Full text Link to item Cite

Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest.

Journal Article J Thorac Cardiovasc Surg · May 2011 OBJECTIVE: Massive perioperative blood product transfusion may be required with thoracic aortic operations and is associated with poor outcomes. We analyzed independent predictors of massive transfusion in thoracic aortic surgical patients undergoing deep ... Full text Link to item Cite

Pulmonary Dysfunction After Thoracic Aortic Surgery Utilizing Deep Hypothermic Circulatory Arrest

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2011 Link to item Cite

Heparin modifies the immunogenicity of positively charged proteins.

Journal Article Blood · December 23, 2010 The immune response in heparin-induced thrombocytopenia is initiated by and directed to large multimolecular complexes of platelet factor 4 (PF4) and heparin (H). We have previously shown that PF4:H multimolecular complexes assemble through electrostatic i ... Full text Link to item Cite

The relationship of plasma transfusion from female and male donors with outcome after cardiac surgery.

Journal Article J Thorac Cardiovasc Surg · December 2010 OBJECTIVE: Pulmonary dysfunction is common in transfused patients recovering from heart surgery. Plasma transfusion from female donors has been linked with rare catastrophic lung injury, but its relationship with outcome after cardiac surgery is poorly und ... Full text Link to item Cite

A clinical prediction tool to estimate the number of units of red blood cells needed in primary elective coronary artery bypass surgery.

Journal Article Transfusion · November 2010 BACKGROUND: Red blood cell (RBC) transfusion is common during cardiac surgical procedures. Empiric crossmatching, without attempting to estimate individual transfusion requirements is typical. We hypothesized that a clinical prediction tool could be develo ... Full text Link to item Cite

Storage age of transfused platelets and outcomes after cardiac surgery.

Journal Article Transfusion · November 2010 BACKGROUND: The relationship between duration of platelet (PLT) storage, currently limited to 5days, and surgical outcomes has not been established. We tested the hypothesis that PLT storage age was associated with adverse outcomes. STUDY DESIGN AND METHOD ... Full text Link to item Cite

Many, but not all, outcome studies support exclusion of female plasma from the blood supply.

Journal Article Expert Rev Hematol · October 2010 Transfusion-related acute lung injury (TRALI) has been identified as the most common cause of transfusion-related death. Although extensive literature supports restrictions on female-donor plasma to reduce antibody-mediated TRALI, only a few outcome studie ... Full text Link to item Cite

Invited commentary.

Other Ann Thorac Surg · July 2010 Full text Link to item Cite

Association of the 98T ELAM-1 polymorphism with increased bleeding after cardiac surgery.

Journal Article J Cardiothorac Vasc Anesth · June 2010 OBJECTIVE: Hemorrhage continues to be a major problem after cardiac surgery despite the routine use of antifibrinolytic drugs, with striking inter-patient variability poorly explained by already known risk factors. The authors tested the hypothesis that ge ... Full text Link to item Cite

Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients.

Journal Article Can J Anaesth · June 2010 PURPOSE: In diabetics, elevated preoperative hemoglobin A1c (HbA1c) levels are associated with increased complication rates after cardiac surgery. While many non-diabetics also have elevated HbA1c, the relationship with outcome in these patients is not wel ... Full text Link to item Cite

Plasmapheresis and heparin reexposure as a management strategy for cardiac surgical patients with heparin-induced thrombocytopenia.

Journal Article Anesth Analg · January 1, 2010 BACKGROUND: Heparin-induced thrombocytopenia (HIT) complicates the management of patients presenting for cardiac surgery, because high-dose heparin anticoagulation for cardiopulmonary bypass is contraindicated in these patients. Alternative anticoagulants ... Full text Link to item Cite

Aprotinin's effect on blood product transfusion in off-pump bilateral lung transplantation.

Journal Article Interact Cardiovasc Thorac Surg · January 2009 In lung transplants necessitating cardiopulmonary bypass (CPB), aprotinin has been shown to decrease transfusion requirements. More recently, off-pump transplantation has become the standard of care. The efficacy of aprotinin use in this population has yet ... Full text Link to item Cite

The effect of aprotinin on outcome after coronary-artery bypass grafting.

Journal Article N Engl J Med · February 21, 2008 BACKGROUND: Aprotinin has recently been associated with adverse outcomes in patients undergoing cardiac surgery. We reviewed our experience with this agent in patients undergoing cardiac surgery at Duke University Medical Center. METHODS: We retrieved data ... Full text Link to item Cite

ABO blood group and bleeding after coronary artery bypass graft surgery.

Journal Article Blood Coagul Fibrinolysis · December 2007 Low circulating von Willebrand factor levels increase the risk of bleeding after cardiac surgery. Patients with blood group O may be at greatest risk owing to lower baseline levels of von Willebrand factor compared with patients with other blood groups, an ... Full text Link to item Cite

Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients.

Journal Article Ann Thorac Surg · September 2007 BACKGROUND: The presence of heparin-induced thrombocytopenia (HIT) increases the risk for thromboembolic events in ventricular assist device (VAD) patients undergoing transplantation. However, cardiopulmonary bypass with alternative anticoagulants is often ... Full text Link to item Cite

Influence of sample collection and storage on the detection of platelet factor 4-heparin antibodies.

Journal Article Am J Clin Pathol · July 2007 Heparin-induced thrombocytopenia is a life threatening thrombotic disorder caused by antibodies to platelet factor 4 (PF4) and heparin. Commercial immunoassays are frequently used for the detection of PF4-heparin antibodies, and several studies have report ... Full text Link to item Cite

Invited commentary.

Journal Article Ann Thorac Surg · July 2007 Full text Link to item Cite

Effect of combined anticoagulation using heparin and bivalirudin on the hemostatic and inflammatory responses to cardiopulmonary bypass in the rat.

Journal Article Anesthesiology · February 2007 BACKGROUND: Despite high-dose heparin anticoagulation, cardiopulmonary bypass (CPB) is still associated with marked hemostatic activation. The purpose of this study was to determine whether a reduced dose of bivalirudin, added as an adjunct to heparin, wou ... Full text Link to item Cite

157: Perioperative predictors of renal failure following off-pump primary double lung transplantation

Conference The Journal of Heart and Lung Transplantation · February 2007 Full text Cite

Genetics of coagulation: considerations for cardiac surgery.

Journal Article Semin Cardiothorac Vasc Anesth · December 2006 Genetic variants in the coagulation system have been known since antiquity. Today, because of modern improvements in diagnosis and medical management, the clinician is likely to encounter a spectrum of coagulation factor deficiencies and identified polymor ... Full text Link to item Cite

The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery.

Journal Article J Cardiothorac Vasc Anesth · August 2006 OBJECTIVE: The objective of this study was to determine the relationship of the kaolin-activated Thrombelastograph (TEG) with postoperative bleeding and laboratory tests of coagulation in the setting of cardiac surgery with the routine use of -aminocaproic ... Full text Link to item Cite

Inflammatory gene polymorphisms and risk of postoperative myocardial infarction after cardiac surgery.

Journal Article Circulation · July 4, 2006 BACKGROUND: The inflammatory response triggered by cardiac surgery with cardiopulmonary bypass (CPB) is a primary mechanism in the pathogenesis of postoperative myocardial infarction (PMI), a multifactorial disorder with significant inter-patient variabili ... Full text Link to item Cite

Thromboelastography detects inadequate response to abciximab therapy during stent-assisted cerebral aneurysm coil embolization complicated by stroke.

Journal Article Neurocrit Care · 2006 INTRODUCTION: Thromboembolic stroke is the most common severe complication following coil embolization of intracerebral aneurysms, with a 5% incidence of permanent deficits. Despite heparin anticoagulation, rescue therapy with the platelet glycoprotein IIb ... Full text Link to item Cite

Recombinant activated factor VII and the anaesthetist.

Journal Article Anaesthesia · December 2005 Recombinant activated factor VII is a safe and effective for the treatment and prevention of haemorrhage in haemophiliacs with circulating inhibitors to replacement factors, and patients with Glanzmann's thrombasthenia refractory to platelet transfusion. B ... Full text Link to item Cite

Preoperative anti-PF4/heparin antibody level predicts adverse outcome after cardiac surgery.

Journal Article J Thorac Cardiovasc Surg · December 2005 OBJECTIVE: Preexisting serum antibodies to heparin/platelet factor 4 complexes may predispose adult cardiac surgical patients to increased perioperative morbidity and mortality. We sought to determine the association between preoperative serum antibodies d ... Full text Link to item Cite

Central venous access

Chapter · December 1, 2005 Full text Cite

Protamine contributes to myocardial ischemia.

Journal Article Anesthesiology · September 2005 Full text Link to item Cite

Infectious complications after cardiac surgery: lack of association with fresh frozen plasma or platelet transfusions.

Journal Article J Cardiothorac Vasc Anesth · August 2005 OBJECTIVE: The purpose of this study was to examine the effect of perioperative transfusion of platelets and fresh frozen plasma (FFP) on infection rates after cardiac surgery. DESIGN: Retrospective study comparing infection rates after cardiac surgery amo ... Full text Link to item Cite

Efficacy and safety of heparinase I versus protamine in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.

Journal Article Anesthesiology · August 2005 BACKGROUND: Hemodynamic protamine reactions with heparin reversal during cardiac surgery are common and associated with adverse outcomes. As an alternative to protamine, the authors examined heparinase I reversal of heparin after aortocoronary bypass graft ... Full text Link to item Cite

Genetic factors contribute to bleeding after cardiac surgery.

Journal Article J Thromb Haemost · June 2005 BACKGROUND: Postoperative bleeding remains a common, serious problem for cardiac surgery patients, with striking inter-patient variability poorly explained by clinical, procedural, and biological markers. OBJECTIVE: We tested the hypothesis that genetic po ... Full text Link to item Cite

Changing systems for measuring activated clotting times: impact on the clinical practice of heparin anticoagulation during cardiac surgery.

Journal Article Clin Chim Acta · June 2005 BACKGROUND: The activated clotting time (ACT) is a standard monitor for heparin anticoagulation during cardiopulmonary bypass (CPB). This study determines the effect of upgrading our ACT system on our clinical practice with regards to the conduct and safet ... Full text Link to item Cite

Hemodynamic changes after protamine administration: association with mortality after coronary artery bypass surgery.

Journal Article Anesthesiology · February 2005 BACKGROUND: Protamine sulfate is standard therapy to reverse heparin anticoagulation. Hemodynamic responses to protamine are common, ranging from minor perturbations to cardiovascular collapse. Although severe fatal reactions occur, the relation of less ex ... Full text Link to item Cite

Preliminary report of the effects of complement suppression with pexelizumab on neurocognitive decline after coronary artery bypass graft surgery.

Journal Article Stroke · October 2004 BACKGROUND AND PURPOSE: Pharmacological modulation of complement activation recently has been postulated as a therapeutic target in the treatment of neurological injury. We hypothesized that pexelizumab, a humanized scFv monoclonal antibody directed agains ... Full text Link to item Cite

Prevention of cerebral hyperthermia during cardiac surgery by limiting on-bypass rewarming in combination with post-bypass body surface warming: a feasibility study.

Journal Article Anesth Analg · September 2004 Cerebral hyperthermia is common during the rewarming phase of cardiopulmonary bypass (CPB) and is implicated in CPB-associated neurocognitive dysfunction. Limiting rewarming may prevent cerebral hyperthermia but risks postoperative hypothermia. In a prospe ... Full text Link to item Cite

An ultrafiltration technique for directly reinfusing residual cardiopulmonary bypass blood.

Journal Article J Extra Corpor Technol · September 2004 Given the shortages of banked blood, the risks of transfusion reactions, disease transmissions, and transfusion errors, we perfusionists must find ways to avoid blood transfusions. At the end of any given bypass run, there is residual blood left in the byp ... Link to item Cite

Preliminary report on the interaction of apolipoprotein E polymorphism with aortic atherosclerosis and acute nephropathy after CABG.

Journal Article Ann Thorac Surg · August 2004 BACKGROUND: Renal dysfunction is a serious complication of cardiac surgery that is highly associated with short- and long-term adverse outcome. While the apolipoprotein E (APOE) epsilon4 allele has been linked to the occurrence of both postcardiac surgery ... Full text Link to item Cite

A multicenter risk index for atrial fibrillation after cardiac surgery.

Journal Article JAMA · April 14, 2004 CONTEXT: Atrial fibrillation is a common, but potentially preventable, complication following coronary artery bypass graft (CABG) surgery. OBJECTIVES: To assess the nature and consequences of atrial fibrillation after CABG surgery and to develop a comprehe ... Full text Link to item Cite

The association of patent foramen ovale and atrial fibrillation after coronary artery bypass graft surgery.

Journal Article Anesth Analg · March 2004 UNLABELLED: Atrial fibrillation (AF) is associated with considerable morbidity and increased resource utilization after coronary artery bypass graft surgery. In this study, we sought to determine whether patent foramen ovale (PFO) and atrial septal aneurys ... Full text Link to item Cite

The genetics of bleeding after cardiac surgery

Conference AMERICAN JOURNAL OF HUMAN GENETICS · November 1, 2003 Link to item Cite

Systemic air embolism during off-pump coronary artery bypass surgery.

Journal Article J Cardiothorac Vasc Anesth · June 2003 Featured Publication Full text Link to item Cite

Lower endotoxin immunity predicts increased cognitive dysfunction in elderly patients after cardiac surgery.

Journal Article Stroke · February 2003 Featured Publication BACKGROUND AND PURPOSE: Although coronary artery bypass graft surgery (CABG) improves the quality of life and functional capacity for numerous patients, many also exhibit impairment in cognitive function immediately after surgery. Although the etiology of ... Full text Link to item Cite

Implementing a New Method for Activated Clotting Time

Journal Article Plastic Surgical Nursing · January 1, 2003 Point-of-care determination of the activated clotting time (ACT) has become the standard of care in a number of clinical situations. The authors converted from ACT done by the Hemochron 801 analyzer, which uses tubes containing either celite, kaolin, or gl ... Full text Cite

Pro: Vasopressin is the vasoconstrictor of choice after cardiopulmonary bypass.

Journal Article J Cardiothorac Vasc Anesth · December 2002 Featured Publication Full text Link to item Cite

Activated clotting time systems vary in precision and bias and are not interchangeable when following heparin management protocols during cardiopulmonary bypass.

Journal Article J Clin Monit Comput · July 2002 Featured Publication OBJECTIVE: Our aim was to test the hypothesis that new activated clotting time (ACT) technology, with modifications to instruments and reagents designed to detect earlier clot formation, would be associated with more precise but lower results. A secondary ... Full text Link to item Cite

The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass.

Journal Article Anesth Analg · May 2002 Featured Publication UNLABELLED: Outcome after cardiac surgery varies depending on complication type. We therefore sought to determine the association between complication type, mortality, and length of stay in a large series of patients undergoing cardiac surgery with cardiop ... Full text Link to item Cite

Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations.

Journal Article Anesth Analg · November 2000 UNLABELLED: Low molecular weight heparin (LMWH) is commonly used to prevent postoperative thromboembolism. Currently, there is no convenient test to measure the degree of anticoagulation from LMWH. This prospective study examines the relationship of thromb ... Full text Link to item Cite

The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery.

Journal Article Anesth Analg · August 1999 UNLABELLED: Vital healthcare resources are devoted to caring for patients with prolonged hospitalization after routine, moderate-risk surgery. Despite the significant cost, little is known about the overall incidence and pattern of complications in these p ... Full text Link to item Cite

Differential diagnosis of perioperative metabolic acidosis

Conference Critical Care Medicine · January 1, 1999 Introduction Perioperatively, metabolic acidosis is commonly ascribed to lactic acidosis secondary to hypoperfusion. Our aim was to determine the exact nature of perioperative acidoses following elective, major surgery. Methods 935 consecutive, perioperati ... Full text Cite

Gut perfusion during cardiac surgery

Journal Article Current Opinion in Anaesthesiology · April 8, 1997 It has been demonstrated that derangements of gut mucosal perfusion and function commonly occur during cardiac surgery. The exact relationship between these observations and the development of postoperative organ dysfunction are areas of debate. However, t ... Full text Cite

Plasma volume support in cardiac surgery

Chapter · January 1, 1997 Cardiac surgery involves major perturbations of normal physiology and organ perfusion including haemorrhage, an extracorporeal circuit, non-pulsatile blood flow, hypothermia and the resulting initiation of a systemic inflammatory response. Varying degrees ... Full text Cite