Perioperative management

Question 1

Risk factor for perioperative blood transfusion requirements

Answer 1

a. age >70
b. emergent or complex
c. dec preop RBC volume (small body size or preop anemia)

Question 2

Blood conservation strategies

Answer 2

Autotransfusion of pre-banked blood
Ultrafiltration
Aminocaproic acid

Question 3

Guidelines for preop CABG anti-thrombotic therapy

Answer 3

1. ASA should be continued preop
2. Tirofiban, eptifibatide (IIb/IIIa inhibitor) - stop 2-4 hours before surgery
3. Abciximab - stop 12 hours before surgery
4. Clopidogrel - stop 5-7 days prior
5. Prasugrel - stop > 7 days before surgery

Question 4

Risk factors for postoperative bleeding after cardiac surgery

Answer 4

Advanced age
Low preoperative red blood cell volume
Preop antiplatelet or antithrombotic drugs
Reoperation or complex procedures
Emergency operations
Long pump time 

Congenital factors:
von Willebrand’s disease
Bernard-Soulier syndrome
Glanzmann’s thrombasthenia

Question 5

Recombinant factor VII procoagulant effect

Answer 5

Binds exposed tissue factor to form thrombin

Question 6

DDAVP procoagulant effect

Answer 6

Stimulates release of von Willebrand’s factor, increases Factor 8 levels

Question 7

Aminocaproic acid and tranexamic acid procoagulant effect

Answer 7

Inhibits fibrinolysis

Displaces plasminogen from fibrin