Smith Mark M, Ashikhmina Elena, Brinkman Nathan J, Barbara David W
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1810-1819. doi: 10.1053/j.jvca.2017.05.017. Epub 2017 May 10.
Coagulopathy and bleeding are common in patients undergoing cardiac surgery, with a perioperative transfusion rate in excess of 50%. The mechanism of coagulopathy associated with cardiac surgery using cardiopulmonary bypass is multifactorial. Historically, coagulation factor-mediated bleeding in such instances has been treated with allogeneic plasma transfusion. Coagulation factor concentrate use for treatment of hemophilia, congenital factor deficiencies and, more recently, emergency warfarin reversal is common. Formulations of factor concentrates include single and multifactor concentrates and both human and recombinant-derived products. Off-label use of factor concentrates for coagulopathy and bleeding associated with cardiac surgery has been described for decades; however, sound clinical research with regard to this practice is limited. This review highlights the literature discussing the use of factor concentrates in patients undergoing cardiac surgery and provides an overview of reasonable uses or lack thereof for factor concentrates in clinical practice.
凝血功能障碍和出血在接受心脏手术的患者中很常见，围手术期输血率超过50%。使用体外循环进行心脏手术相关的凝血功能障碍机制是多因素的。从历史上看，在这种情况下，凝血因子介导的出血一直通过输注异体血浆来治疗。凝血因子浓缩物用于治疗血友病、先天性因子缺乏症，以及最近用于紧急华法林逆转很常见。因子浓缩物的制剂包括单因子和多因子浓缩物，以及人源和重组衍生产品。几十年来，一直有关于将因子浓缩物用于与心脏手术相关的凝血功能障碍和出血的非适应证使用的描述；然而，关于这种做法的可靠临床研究有限。这篇综述重点介绍了讨论在接受心脏手术的患者中使用因子浓缩物的文献，并概述了因子浓缩物在临床实践中的合理用途或缺乏合理用途的情况。
