The effect of non-point-of-care haemostasis management protocol implementation in cardiac surgery: A systematic review.

Transfusion Medicine
Reinier P J BoxmaMichael I Meesters

Abstract

This systematic review aims to outline the evidence on the implementation of a non-point-of-care (non-point-of-care [POC]) haemostasis management protocol compared to experience-based practice in adult cardiac surgery. Management of coagulopathy in cardiac surgery is complex and remains highly variable among centres and physicians. Although various guidelines recommend the implementation of a transfusion protocol, the literature on this topic has never been systematically reviewed. PubMed, Embase, Cochrane Library, and Web of Science were searched from January 2000 till May 2020. A total of seven studies (one randomised controlled trial [RCT], one prospective cohort study, and five retrospective studies) met the inclusion criteria. Among the six non-randomised, controlled studies, the risk of bias was determined to be serious to critical, and the one RCT was determined to have a high risk of bias. Five studies showed a significant reduction in red blood cells, fresh frozen plasma, and/or platelet transfusion after the implementation of a structural non-POC algorithm, ranging from 2% to 28%, 2% to 19.5%, and 7% to17%, respectively. One study found that fewer patients required transfusion of any blood component in the protocol gr...Continue Reading

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