A review of European guidelines for patient blood management with a particular emphasis on antifibrinolytic drug administration for cardiac surgery

Andrew Klein*, Seema Agarwal, Bernard Cholley, Jens Fassl, Michael Griffin, Timo Kaakinen, Patrick Paulus, Steffen Rex, Martin Siegemund, Annewil van Saet

*Corresponding author for this work

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Abstract

The concept of patient blood management (PBM) was introduced by the World Health Organization in 2011 and is defined as a “patient-focused, evidence-based and systematic approach for optimizing the management of patients and transfusion of blood products to ensure high quality and effective patient care”. Patient blood management is a multimodal approach based on three pillars: optimization of blood mass, minimization of blood loss and optimization of patient tolerance to anaemia. Antifibrinolytics play a major role in cardiac surgery, where the risk of perioperative bleeding is high and affects a majority of patients, by effectively reducing bleeding, transfusions, re-operations, as well as their associated morbidity and mortality. They represent an essential part of the pharmacological arsenal of patient blood management. However, despite the trend towards high-level PBM practices, currently very few European countries have national PBM guidelines and these guidelines, taken as a whole, are heterogeneous in form and content. In particular, the use of antifibrinolytics in cardiac surgery is often not discussed in detail beyond general prophylactic use and any recommendations lack detail including choice of drug, dosing, and mode of administration. Thus, the implementation of PBM programs in Europe is still challenging. In 2021, the WHO published a new document highlighting the urgent need to close the gap in PBM awareness and implementation and announced their upcoming initiative to develop specific PBM implementation guidelines. This review aims first, to summarize the role played by fibrinolysis in haemostatic disorders; second, to give an overview of the current available guidelines in Europe detailing PBM implementation in cardiac surgery; and third, to analyse the place and use of antifibrinolytics in these guidelines.

Original languageEnglish
Article number110654
JournalJournal of Clinical Anesthesia
Volume78
Early online date19 Jan 2022
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
SA has received honoraria and/or research funding from Haemonetics, Nordic Pharma, Octopharma and Pharmacosmos.

Funding Information:
This work was supported by Nordic Pharma , for the institutional support, and Public Health Expertise for the medical writing support.

Publisher Copyright:
© 2022 The Authors

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