BACKGROUND Cardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients with hereditary and acquired bleeding disorders to assess pertinent outcomes, including perioperative haemorrhage, thromboembolism, and hospital costs. METHODS We conducted a retrospective cohort study using the Premier Health Database, including adult cardiac surgical patients diagnosed with hereditary or acquired bleeding disorders compared with those without bleeding disorders. RESULTS Patients with acquired bleeding disorders required more extensive use of coagulation factor concentrates and blood products compared with those with hereditary bleeding disorders or without bleeding disorders. The highest exposures to coagulation factor concentrates were found in the acquired bleeding disorders group, with 24% receiving factor VIIa and 11.7% receiving prothrombin complex concentrate. This group also experienced significantly higher rates of complications, including a 15.8% rate of haemorrhage and a 19.2% rate of thromboembolic events. The acquired bleeding disorders group had longer intensive care and hospital stays, and the highest mortality rate (19.2%). The increased use of perioperative replacement of factor VIII and factor IX in the hereditary bleeding disorders group led to increased pharmacy costs but did not significantly impact blood bank charges. CONCLUSIONS Acquired bleeding disorders in cardiac surgery patients are associated with increased use of haemostatic interventions, postoperative complications, and increased healthcare costs. Improved management of perioperative haemostasis and thromboprophylaxis strategies are essential for optimising patient outcomes and reducing expenses.

中文翻译：

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凝血因子浓缩物和输血在心脏手术中的应用：一项针对患有遗传性和获得性出血性疾病的成人的回顾性队列研究。


背景 心脏手术对围手术期出血和同种异体输血构成重大风险，尤其是对于出血性疾病患者。凝血因子浓缩物的日益频繁使用可能会影响出血风险、血栓栓塞事件和成本。我们描述了凝血因子浓缩物和同种异体血液制品在患有遗传性和获得性出血性疾病的心脏外科患者中的使用，以评估相关结局，包括围手术期出血、血栓栓塞和住院费用。方法 我们使用 Premier Health 数据库进行了一项回顾性队列研究，包括诊断为遗传性或获得性出血性疾病的成年心脏外科患者与无出血性疾病的患者的比较。结果 与遗传性出血性疾病或无出血性疾病的患者相比，获得性出血性疾病患者需要更广泛地使用凝血因子浓缩物和血液制品。获得性出血性疾病组对凝血因子浓缩物的暴露量最高，24% 接受凝血因子 VIIa，11.7% 接受凝血酶原复合物浓缩物。该组的并发症发生率也显著更高，包括 15.8% 的出血率和 19.2% 的血栓栓塞事件发生率。获得性出血性疾病组的重症监护和住院时间更长，死亡率最高 （19.2%）。遗传性出血性疾病组围手术期 VIII 因子和 IX 因子替代治疗的使用增加导致药房成本增加，但未对血库费用产生显著影响。 结论 心脏手术患者获得性出血性疾病与止血干预使用增加、术后并发症和医疗保健成本增加有关。改进围手术期止血和血栓预防策略的管理对于优化患者结局和减少费用至关重要。