患者血液管理：阜外医院单中心证据和实践

doi:10.24920/004035

Highlight

There is a great burden on the blood supply in China. Over the past decade, Fuwai Hospital has established a multidisciplinary strategy in patient blood management (PBM) which has been demonstrated effective in decreasing transfusion rates and blood consumption, and also contributes to shortening the length of in-hospital stay and lowering the in-hospital mortalities. This paper introduces the strategy of PBM, highlights the evidence and practice of patient blood management at Fuwai Hospital.

Abstract

Blood loss and blood transfusion requirement are important quality control indicators of cardiovascular surgery and cardiovascular anesthesia. Patient blood management (PBM) is an evidence-based, multidisciplinary approach to optimizing the care of patients who may need transfusion, which encompasses anemia management, hemodilution, cell salvage, hemostatic treatment, and other approaches to reducing bleeding and minimizing blood transfusion. PBM in cardiovascular surgery is a “team sport” that involves cardiac and vascular surgeons, anesthesiologists, perfusionist, intensivists, and other health care providers. The current work provides an overview of evidence and practice of PBM at Fuwai Hospital. Implementation of PBM should also take local resource availability and cost-effectiveness of different devices, drugs, technologies, and techniques into consideration.

Key words: bleeding, blood transfusion, blood management, cardiovascular surgery, anesthesia

Yuntai Yao, Xin Yuan, Lixian He, Yiping Yu, Yu Du, Gang Liu, Lijuan Tian, Zuxuan Ma, Yongbao Zhang, Jie Ma. Patient Blood Management: Single Center Evidence and Practice at Fuwai Hospital[J].Chinese Medical Sciences Journal, 2022, 37(3): 246-260.

Figures/Tables 4

Table 1.

Patient blood management at Fuwai Hospital"

1.	Establishment of a THREE-level administration model. Level ONE: Blood Transfusion Administration Committee of Fuwai Hospital with the hospital president as the director. Level TWO: Department of Medical Affairs. Level THREE: Department of Blood Transfusion.
2.	Organization of a multiple-disciplinary patient blood management team. Designation of a coordinator responsible for the affairs related to blood transfusion.
3.	Enactment and revision of the Blood Transfusion Management Protocols of Fuwai Hospital, which include not only the indications of peri-operative blood transfusion (See below in Item 6) in cardiovascular surgical patients, but also the respective responsibility of surgeons, anesthesiologists, perfusionists and intensivists and detailed guidance for them. The roles of Department of Medical Affairs and Department of Blood Transfusion in blood transfusion management are also clearly defined.
4.	Adoption of a Blood Consumption Announcement and Scoring System, which regularly publishes notifications of blood volume consumption per surgical case, blood volume consumption per single disease and blood volume consumption per surgeon. The blood volume consumption per surgeon when treating a single disease, has also been incorporated as a criterion to determine the monthly bonus and performance excellency of all surgical wards.
5.	To guarantee the effectiveness of these strategies, regular inspection and evaluation of the implementation and amendments are made when necessary.
6.	Transfusion threshold/triggers RBC transfusion is indicated when: ①Hb concentration < 70 g/L during CPB ②Hb concentration < 80 g/L (post-hemofiltration) after weaning from CPB ③Hb concentration < 80 g/L after transfusion of salvaged and/or pump blood ④Hb concentration < 80 g/L in patients undergoing off-pump cardiovascular surgeries ⑤Hb concentration < 90 g/L in aged patients ⑥Hb concentration < 90 g/L in aortic surgical patients FFP transfusion is indicated when: ①Diffuse bleeding with PT >1.5-fold of normal value, APTT > 2.0-fold of normal value ②Massive blood transfusion with transfused volume ≥ estimated total blood volume (70 ml/kg body weight) ③Transfused volume of salvaged blood >2,000 ml ④Inherited or acquired coagulopathies ⑤Coagulation factors deficiency evidenced by TEG ⑥Immediate reversal of warfarin effect ⑦Antithrombin Ⅲ deficiency (“heparin resistance”) ⑧Vitamin K deficiency PC transfusion is indicated when: ①Platelet count < 50 × 10⁹/L ②Re-do cardiovascular surgeries, aortic surgeries, heart transplantation ③Lengthy CPB (duration > 6 h) ④Massive transfusion of allogeneic blood ⑤Platelet dysfunction indicated by TEG

Table 1.

Figure 1.

Figure 2.

Table 2.

References 100.

1.	Görlinger K, Shore-Lesserson L, Dirkmann D, et al. Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth 2013; 27(Suppl 4):S20-34. doi: 10.1053/j.jvca.2013.05.014. doi: 10.1053/j.jvca.2013.05.014
2.	Shander AS, Goodnough LT. Blood transfusion as a quality indicator in cardiac surgery. JAMA 2010; 304(14):1610-1. doi: 10.1001/jama.2010.1483. doi: 10.1001/jama.2010.1483 pmid: 20940390
3.	Yu X, Huang Y, Qu G, et al. Safety and current status of blood transfusion in China. Lancet 2010; 375(9724):1420-1. doi: 10.1016/S0140-6736(10)60003-7. doi: 10.1016/S0140-6736(10)60003-7 pmid: 20347128
4.	Yu X, Chen W, Liu Z, et al. Safety and current status of blood transfusion in China: an update. Lancet Hematol 2016; 3(2):e60-2. doi: 10.1016/S2352-3026(16)00010-7. doi: 10.1016/S2352-3026(16)00010-7
5.	Lu J, Cheng W, Huang J. Report on cardiac anesthesia progress and challenges in China. J Cardiothorac Vasc Anesth 2018; 32(5):2365-71. doi: 10.1053/j.jvca.2017.12.050. doi: S1053-0770(17)31042-X pmid: 29397293
6.	Lu J, Wang W, Cheng W, et al. Current status of cardiovascular anesthesia in China. Anesth Analg 2017; 125(6):1855-62. doi: 10.1213/ANE.0000000000002051. doi: 10.1213/ANE.0000000000002051 pmid: 28489638
7.	Shan H, Zhang P. Viral attacks on the blood supply: the impact of severe acute respiratory syndrome in Beijing. Transfusion 2004; 44(4):467-9. doi: 10.1111/j.0041-1132.2004.04401.x. doi: 10.1111/j.0041-1132.2004.04401.x pmid: 15043559
8.	Duru F. Fuwai Hospital, Beijing, China: the world’s largest cardiovascular science centre with more than 1200 beds. Eur Heart J 2018; 39(6):428-9. doi: 10.1093/eurheartj/ehx804. doi: 10.1093/eurheartj/ehx804
9.	Li LH. The effects of cardiopulmonary bypass on coagulation and thrombosis. Int J Anesth Resus 1981; 1:9-15.
10.	Hu RL, Sun YP, Liu J, et al. The application of activated clotting time response curve on calculating protamine dosages. Chin Circ J 1988; 2:119-21. doi: 10.3321/j.issn:1000-3614.1988.02.036. doi: 10.3321/j.issn:1000-3614.1988.02.036
11.	Hu RL, Liu J, Xu SC. Optimal dose of domestic and imported protamine on heparin. Chin Circ J 1989; 4:366-7. doi: 10.3321/j.issn:1000-3614.1989.04.031. doi: 10.3321/j.issn:1000-3614.1989.04.031
12.	Liu J, Hu RL, Xu SC. The protamine reversal after residue pump blood transfusion. Chin Circ J 1990; 2:159-60. doi: 10.3321/j.issn:1000-3614.1990.02.034. doi: 10.3321/j.issn:1000-3614.1990.02.034
13.	Long C, Hu XQ, Deng SZ. Heparinization during cardiopulmonary bypass. Int J Anesth Resus 1992; 1:3-6.
14.	Long C, Hu XQ. Anticoagulation for contact activation-heparin coated circuit. Int J Bio Eng 1993; 4:201-5.
15.	Hu XQ, Wu XR, Long C, et al. Autotransfusion during open heart surgery. Acta Acad Med Sin 1994; 4:284. doi: 10.3321/j.issn:1000-503X.1994.04.012. doi: 10.3321/j.issn:1000-503X.1994.04.012
16.	Deng SZ, Liu J. Blood transfusion and related adverse events. J Clin Anesth 1995; 1:31. doi: 10.1016/0952-8180(88)90008-6
17.	Wu QY. Reduction of blood transfusion in cardiovascular surgery. Chin Circ J 2000; 15:372. doi: 10.3321/j.issn:1000-3614.2000.06.032. doi: 10.3321/j.issn:1000-3614.2000.06.032
18.	Ji H, Li Z, Sun H, et al. Effects of multidisciplinary blood management strategy on transfusion and outcomes in patients undergoing valvular heart surgery. Zhonghua Yi Xue Za Zhi 2014; 94(7):488-90. Chinese. doi: 10.3760/cma.j.issn.0376-2491.2014.07.004. doi: 10.3760/cma.j.issn.0376-2491.2014.07.004
19.	Fuwai Hospital, CAMS National Center for Cardiovascular diseases. Cardiovascular surgery outcomes 2019. Available from: https://www.fuwai.com/Sites/Uploaded/File/2020/8/2019waike.pdf. Accessed: April 1, 2021.
20.	Hansson EC, Jeppsson A. Platelet inhibition and bleeding complications in cardiac surgery: a review. Scand Cardiovasc J 2016; 50(5-6):349-54. doi: 10.1080/14017431.2016.1231935. doi: 10.1080/14017431.2016.1231935 pmid: 27590033
21.	Levy JH, Rossaint R, Zacharowski K, et al. What is the evidence for platelet transfusion in perioperative settings? Vox Sang 2017; 112(8):704-12. doi: 10.1111/vox.12576. doi: 10.1111/vox.12576 pmid: 28952153
22.	Thiele T, Greinacher A. Platelet transfusion in perioperative medicine. Semin Thromb Hemost 2020; 46(1):50-61. doi: 10.1055/s-0039-1697951. doi: 10.1055/s-0039-1697951 pmid: 31830766
23.	Pan N, Gao XR, Jia JN, et al. Analysis of the characteristics of platelet transfusion in cardiovascular surgery. Beijing Med 2016; 38:1221-4. doi: 10.15932/j.0253-9713.2016.11.026. doi: 10.15932/j.0253-9713.2016.11.026
24.	Wu H, Hu SS, Zheng Z, et al. Predictors of perioperative blood transfusion after coronary artery bypass grafting. Chin J Blood Transfusion 2012; 25:336-40. doi: 10.13303/j.cjbt.issn.1004-549x.2012.04.035. doi: 10.13303/j.cjbt.issn.1004-549x.2012.04.035
25.	Chen L, Lv L, Long C, et al. Evaluation of risk factors on red blood cells transfusion for patients underwent coronary artery bypass grafting perioperatively. Chin J Clin Thorac Cardiovasc Surg 2016; 23:653-7.
26.	Zhang W, Chen S, Liu X, et al. Can higher body mass index patients save blood following on-pump coronary artery bypass grafting? Heart Surg Forum 2019; 22(5):E352-6. doi: 10.1532/hsf.2559. doi: 10.1532/hsf.2559
27.	Wang M, Chen M, Ao H, et al. The effects of different BMI on blood loss and transfusions in Chinese patients undergoing coronary artery bypass grafting. Ann Thorac Cardiovasc Surg 2017; 23(2):83-90. doi: 10.5761/atcs.oa.16-00219. doi: 10.5761/atcs.oa.16-00219
28.	Liu X, Zhang W, Chen N, et al. Can preoperative C-reactive protein predict bleeding after on-pump coronary artery bypass grafting? Ann Thorac Surg 2020; 109(2):541-6. doi: 10.1016/j.athoracsur. doi: S0003-4975(19)31158-0 pmid: 31404545
29.	Shen RH, Wang X, Lu ZY, et al. Development of nomogram predicting postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot. Chin J Clin Thorac Cardiovasc Surg 2020; 28(4):409-15. doi: 10.7507/1007-4848.202003089. doi: 10.7507/1007-4848.202003089
30.	Horvath KA, Acker MA, Chang H, et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg 2013; 95(6):2194-201. doi: 10.1016/j.athoracsur.2012.11.078. doi: 10.1016/j.athoracsur.2012.11.078 pmid: 23647857
31.	Reeves BC, Murphy GJ. Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery. Curr Opinion Cardiol 2008; 23(6):607-12. doi: 10.1097/ACO.0b013e32830dd087. doi: 10.1097/ACO.0b013e32830dd087
32.	Ranucci M. Outcome measures and quality markers for perioperative blood loss and transfusion in cardiac surgery. Can J Anesth 2016; 63(2):169-75. doi: 10.1007/s12630-015-0515-8. doi: 10.1007/s12630-015-0515-8
33.	Wu H, Hu SS, Zheng Z, et al. Influence of perioperative blood transfusion on short-term, long-term outcomes after coronary artery bypass grafting. Chin Gen Pract 2013; 16(30):3554-8. doi: 10.3969/j.issn.1007-9572.2013.28.083. doi: 10.3969/j.issn.1007-9572.2013.28.083
34.	Wang XQ, Sun ZQ, Gao HW, et al. Impact of blood transfusion on the prognosis for patients with coronary artery bypass grafting. Chin J Blood Transfusion 2017, 30(12):1353-6. doi: 10.13303/j.cjbt.issn.1004-549x.2017.12.011. doi: 10.13303/j.cjbt.issn.1004-549x.2017.12.011
35.	Yao YT, Li LH, Lei Q, et al. Noninfectious fever following aortic surgery: incidence, risk factors, and outcomes. Chin Med Sci J 2009; 24(4):213-9. doi: 10.1016/s1001-9294(10)60004-1. doi: 10.1016/s1001-9294(10)60004-1
36.	Xu DQ, Wu H, Zhang HT, et al. Risk factors of postoperative hyperbilirubinemia in cardiac surgical patients. Chin J Med 2014; 49:19-21. doi: 10.3969/j.issn.1008-1070.2014.06.006. doi: 10.3969/j.issn.1008-1070.2014.06.006
37.	Padmanabhan H, Siau K, Curtis J, et al. Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta-analysis. Ann Thorac Surg 2019; 108(6):1840-8. doi: 10.1016/j.athoracsur.2019.04.108. doi: S0003-4975(19)30874-4 pmid: 31233718
38.	Dhir A, Tempe DK. Anemia and patient blood management in cardiac surgery—literature review and current evidence. J Cardiothorac Vasc Anesth 2018; 32(6):2726-42. doi: 10.1053/j.jvca.2017.11.043. doi: 10.1053/j.jvca.2017.11.043
39.	Xu H, Duan Y, Yuan X, et al. Intravenous iron versus placebo in the management of postoperative functional iron deficiency anemia in patients undergoing cardiac valvular surgery: a prospective, single-blinded, randomized controlled trial. J Cardiothorac Vasc Anesth 2019; 33(11):2941-8. doi: 10.1053/j.jvca.2019.01.063. doi: 10.1053/j.jvca.2019.01.063
40.	Wang S, Lv S, Guan Y, et al. Cardiopulmonary bypass techniques and clinical outcomes in Beijing Fuwai Hospital: a brief clinical review. ASAIO J 2011; 57(5):414-20. doi: 10.1097/MAT.0b013e318227fa72. doi: 10.1097/MAT.0b013e318227fa72 pmid: 21734556
41.	Xiong Y, Sun Y, Ji B, et al. Systematic review and meta-snalysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery. Paediatr Anesth 2015; 25(2):135-42. doi: 10.1111/pan.12560. doi: 10.1111/pan.12560
42.	Chen L, Lv L, Long C, et al. Effects of circuit albumin coating on coagulation and inflammatory response for patients receiving aortic arch replacement: a randomized controlled trial. Perfusion 2016; 31(7):576-83. doi: 10.1177/0267659116645662. doi: 10.1177/0267659116645662 pmid: 27117175
43.	Gao S, Li Y, Diao X, et al. Vacuum-assisted venous drainage in adult cardiac surgery: a propensity-matched study. Interact Cardiovasc Thorac Surg 2020; 30(2):236-42. doi: 10.1093/icvts/ivz253. doi: 10.1093/icvts/ivz253
44.	Liu G, Zeng QD, Zheng Z, et al. Clinical application of modified minimally cardiopulmonary bypass: compared with conventional cardiopulmonary bypass. Zhonghua Wai Ke Za Zhi 2016; 54(8):613-6. doi: 10.3760/cma.j.issn.0529-5815.2016.08.012. doi: 10.3760/cma.j.issn.0529-5815.2016.08.012
45.	Yan S, Zhao Y, Lou S. Ultrafiltration and reinfusion of residual cardiopulmonary bypass pump blood: a prospective non-randomized controlled study. Artif Organs 2019; 43(7):641-6. doi: 10.1111/aor.13412. doi: 10.1111/aor.13412 pmid: 30589449
46.	Ferraris VA, Brown JR, Despotis GT, et al. Society of Thoracic Surgeons Blood Conservation Guideline Task Force. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91(3):944-82. doi: 10.1016/j.athoracsur.2010.11.078. doi: 10.1016/j.athoracsur.2010.11.078 pmid: 21353044
47.	Tian L, Gao X, Yang J, et al. Association of adenosine diphosphate-induced platelet maximum amplitude with postoperative bleeding and blood transfusions in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2021; 35(2):421-8. doi: 10.1053/j.jvca.2020.07.009. doi: 10.1053/j.jvca.2020.07.009 pmid: 32758409
48.	Ji HW, Deng SZ. Changes of plasma heparin concentration during cardiopulmonary bypass. J Clin Anesth 2003; 19(3):139-41. doi: 10.3969/j.issn.1004-5805.2003.03.003. doi: 10.3969/j.issn.1004-5805.2003.03.003
49.	Boer C, Meesters MI, Veerhoek D, et al. Anticoagulant and side-effects of protamine in cardiac surgery: a narrative review. Br J Anaesth 2018; 120(5):914-27. doi: 10.1016/j.bja.2018.01.023. doi: S0007-0912(18)30061-8 pmid: 29661409
50.	Wang G, Xie G, Jiang T, et al. Tranexamic acid reduces blood loss after off-pump coronary surgery: a prospective, randomized, double-blind, placebo-controlled study. Anesth Analg 2012; 115(2):239-43. doi: 10.1213/ANE.0b013e3182264a11. doi: 10.1213/ANE.0b013e3182264a11 pmid: 21737704
51.	Wang JH, Han ZY, Lin L, et al. Anesthetic management for 1-stop hybrid revascularization of coronary artery disease. Natl Med J China 2010; 90(17):1181-3. doi: 10.3760/cma.j.issn.0376-2491.2010.17.008. doi: 10.3760/cma.j.issn.0376-2491.2010.17.008
52.	Zhu GY, Shi SH, Zhang BZ, et al. Hemodilution and autotransfusion during cardiovascular surgery: a serial report of 100 cases. Chin J Blood Transfusion 1990; 3(3):122-4. doi: 10.13303/j.cjbt.issn.1004-549x.1990.03.010. doi: 10.13303/j.cjbt.issn.1004-549x.1990.03.010
53.	Schaff HV, Hauer J, Gardner TJ, et al. Routine use of autotransfusion following cardiac surgery: experience in 700 patients. Ann Thorac Surg 1979; 27(6):493-9. doi: 10.1016/s0003-4975(10)63357-7. doi: 10.1016/s0003-4975(10)63357-7 pmid: 313198
54.	Zhao K, Xu J, Hu S, et al. Autotransfusion of shed mediastinal blood after open heart surgery. Chin Med J (Engl) 2003; 116(8):1179-82.
55.	Wang G, Bainbridge D, Martin J, et al. The efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials. Anesth Analg 2009; 109(2):320-30. doi: 10.1213/ane.0b013e3181aa084c. doi: 10.1213/ane.0b013e3181aa084c pmid: 19608798
56.	Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood 1990; 76(9):1680-97. pmid: 2224118
57.	Shi S, Wang GY. Preoperative autologous plateletpheresis in cardiac surgery—70 cases experiences at Fuwai Hospital. Mol Cardio Chin 2018; 18(6):2678-81. doi: 10.16563/j.cnki.1671-6272.2018.12.009. doi: 10.16563/j.cnki.1671-6272.2018.12.009
58.	Takagi H, Manabe H, Kawai N, et al. Aprotinin increases mortality as compared with tranexamic acid in cardiac surgery: a meta-analysis of randomized head-to-head trials. Interact Cardiovasc Thorac Surg 2009; 9(1):98-101. doi: 10.1510/icvts.2008.198325 doi: 10.1510/icvts.2008.198325
59.	Liu MZ, Zhang DY, Hu XQ. The application of aprotinin in open heart surgery. Chin Circ J 1994; 9(10): 611-3. doi: 10.3321/j.issn:1000-3614.1994.10.025. doi: 10.3321/j.issn:1000-3614
60.	Fergusson DA, Hébert PC, Mazer CD, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008; 358(22):2319-31. doi: 10.1056/NEJMoa0802395. doi: 10.1056/NEJMoa0802395
61.	Wang X, Zheng Z, Ao H, et al. A comparison before and after aprotinin was suspended in cardiac surgery: different results in the real world from a single cardiac center in China. J Thorac Cardiovasc Surg 2009; 138(4):897-903. doi: 10.1016/j.jtcvs.2009.03.021. doi: 10.1016/j.jtcvs.2009.03.021 pmid: 19660368
62.	Wang X, Zheng Z, Ao H, et al. Effects of aprotinin on short-term and long-term outcomes after coronary artery bypass grafting surgery. Ann Thorac Surg 2010; 89(5):1489-95. doi: 10.1016/j.athoracsur.2010.02.006. doi: 10.1016/j.athoracsur.2010.02.006 pmid: 20417766
63.	Ji BY, Liu JP, Liu MZ, et al. Effects of urinary protease inhibitor on inflammatory response during on-pump coronary revascularisation. Effect of ulinastatin on inflammatory response. J Cardiovasc Surg (Torino) 2007; 48(4):497-503.
64.	Yao YT, Fang NX, Liu DH, et al. Ulinastatin reduces postoperative bleeding and red blood cell transfusion in patients undergoing cardiac surgery: a PRISMA-compliant systematic review and meta-analysis. Medicine 2020; 99(7):e19184. doi: 10.1097/MD.0000000000019184. doi: 10.1097/MD.0000000000019184
65.	Zhang P, Lv H, Qi X, et al. Effect of ulinastatin on post-operative blood loss and allogeneic transfusion in patients receiving cardiac surgery with cardiopulmonary bypass: a prospective randomized controlled study with 10-year follow-up. J Cardiothorac Surg 2020; 15(1):98. doi: 10.1186/s13019-020-01144-9. doi: 10.1186/s13019-020-01144-9 pmid: 32410683
66.	Wang HL, Li L, Zhou Y, et al. Effects of ulinastatin in infants undergoing repair surgery for ventricular septal defect. Mol Cardiovasc Chin 2019; 19(5):3061-3. doi: 10.16563/j.cnki.1671-6272.2019.10.007. doi: 10.16563/j.cnki.1671-6272.2019.10.007
67.	Lv H, Li L, Lv HR, et al. The pulmonary protective effect of ulinastatin in pediatric patients undergoing radical surgery for tetralogy of Fallot and its 7-year follow-up results. Chin J ECC 2019; 17(3):153-6. doi: 10.13498/j.cnki.chin.j.ecc.2019.03.07. doi: 10.13498/j.cnki.chin.j.ecc.2019.03.07
68.	Yao YT, He LX, Tan JC. The effect of tranexamic acid on the values of activated clotting time in patients undergoing cardiac surgery: a PRISMA-compliant systematic review and meta-analysis. J Clin Anesth 2020; 67:110020. doi: 10.1016/j.jclinane.2020.110020. doi: 10.1016/j.jclinane.2020.110020
69.	Zhang Y, Gao X, Yuan S, et al. Effects of tranexamic acid on short-term and long-term outcomes of on-pump coronary artery bypass grafting: randomized trial and 7-year follow-up. Cardiovasc Ther 2018; 36(6):e12472. doi: 10.1111/1755-5922.12472. doi: 10.1111/1755-5922.12472
70.	Shi J, Wang G, Lv H, et al. Tranexamic acid in on-pump coronary artery bypass grafting without clopidogrel and aspirin cessation: randomized trial and 1-year follow-up. Ann Thorac Surg 2013; 95(3):795-802. doi: 10.1016/j.athoracsur.2012.07.015. doi: 10.1016/j.athoracsur.2012.07.015 pmid: 22959576
71.	Shi J, Ji H, Ren F, et al. Protective effects of tranexamic acid on clopidogrel before coronary artery bypass grafting: a multicenter randomized trial. JAMA Surg 2013; 148(6):538-47. doi: 10.1001/jamasurg.2013.1560. doi: 10.1001/jamasurg.2013.1560 pmid: 23426385
72.	Zhang Y, Zhang X, Wang Y, et al. Efficacy and safety of tranexamic acid in pediatric patients undergoing cardiac surgery: a single-center experience. Front Pediatr 2019; 7:181. doi: 10.3389/fped.2019.00181. doi: 10.3389/fped.2019.00181 pmid: 31134172
73.	Du Y, Xu J, Wang G, et al. Comparison of two tranexamic acid dose regimens in patients undergoing cardiac valve surgery. J Cardiothorac Vasc Anesth 2014; 28(5):1233-7. doi: 10.1053/j.jvca.2013.10.006. doi: 10.1053/j.jvca.2013.10.006 pmid: 24447498
74.	Lin DM, Murphy LS, Tran MH. Use of prothrombin complex concentrates and fibrinogen concentrates in the perioperative setting: a systematic review. Transfus Med Rev 2013; 27(2):91-104. doi: 10.1016/j.tmrv.2013.01.002. doi: 10.1016/j.tmrv.2013.01.002 pmid: 23462530
75.	Cui YL, Liu JP, Feng ZY, et al. Effect of fibrinogen on perioperative coagulation and short time prognosis for severe cyanotic congenital heart disease patients undergoing complex cardiac surgery. J Appl Clin Pediatr 2012; 27(19):1533-5. doi: 10.3969/j.issn.1003-515X.2012.19.026. doi: 10.3969/j.issn.1003-515X.2012.19.026
76.	Li JY, Gong J, Zhu F, et al. Fibrinogen concentrate in cardiovascular surgery: a meta-analysis of randomized controlled trials. Anesth Analg 2018; 127(3):612-21. doi: 10.1213/ANE.0000000000003508. doi: 10.1213/ANE.0000000000003508
77.	Ghadimi K, Levy JH, Welsby IJ. Prothrombin complex concentrates for bleeding in the perioperative setting. Anesth Analg 2016; 122(5):1287-300. doi: 10.1213/ANE.0000000000001188. doi: 10.1213/ANE.0000000000001188 pmid: 26983050
78.	Ponschab M, Landoni G, Biondi-Zoccai G, et al. Recombinant activated factor VII increases stroke in cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2011; 25(5):804-10. doi: 10.1053/j.jvca.2011.03.004. doi: 10.1053/j.jvca.2011.03.004 pmid: 21596585
79.	Zangrillo A, Mizzi A, Biondi-Zoccai G, et al. Recombinant activated factor Ⅶ in cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2009; 23(1):34-40. doi: 10.1053/j.jvca.2008.09.017. doi: 10.1053/j.jvca.2008.09.017 pmid: 19081268
80.	Li Y, Zhao W, Luo Q, et al. A propensity-score matched analysis on outcomes using recombinant activated factor Ⅶ in pediatric cardiac surgery. J Cardiothorac Vasc Anesth 2019; 33(5):1269-75. doi: 10.1053/j.jvca.2018.12.016 doi: 10.1053/j.jvca.2018.12.016
81.	Cattaneo M. The use of desmopressin in open-heart surgery. Hemophilia 2008; 14 (Suppl 1):40-7. doi: 10.1111/j.1365-2516.2007.01608.x. doi: 10.1111/j.1365-2516.2007.01608.x
82.	Jin L, Ji HW. Effect of desmopressin on platelet aggregation and blood loss in patients undergoing valvular heart surgery. Chin Med J (Engl) 2015; 128(5):644-7. doi: 10.4103/0366-6999.151663. doi: 10.4103/0366-6999.151663
83.	Zhao WB, Li J. Application of desmopressin during cardiopulmonary bypass in heart surgery. Hainan Med J 2013; 24(12):1737-9.
84.	Sankar MJ, Chandrasekaran A, Kumar P, et al. Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review. J Perinatol 2016; 36(Suppl 1):S29-35. doi: 10.1038/jp.2016.30. doi: 10.1038/jp.2016.30
85.	Yiu KH, Siu CW, Jim MH, et al. Comparison of the efficacy and safety profiles of intravenous vitamin K and fresh frozen plasma as treatment of warfarin-related over-anticoagulation in patients with mechanical heart valves. Am J Cardiol 2006; 97(3):409-11. doi: 10.1016/j.amjcard.2005.08.062. doi: 10.1016/j.amjcard.2005.08.062
86.	Lv XD, Long C, Yao YL, et al. Effect of vitamin K 1 on perioperative blood coagulation factors during open heart surgery in Children. Chin J Clin Thorac Cardiovasc Surg 2001; 8(1):8-11.
87.	Lv XD, Long C, Yao YL, et al. The effects of preoperative intramuscular injection of vitamin K on coagulation in patients undergoing open heart surgery. Shandong Med J 2000; 40(23):19-21.
88.	Yao YT, Yuan X, Fang NX. Hemocoagulase reduces postoperative bleeding and blood transfusion in cardiac surgical patients: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98(52):e18534. doi: 10.1097/MD.0000000000018534. doi: 10.1097/MD.0000000000018534
89.	Pereira BM, Bortoto JB, Fraga GP. Topical hemostatic agents in surgery: review and prospects. Rev Col Bras Cir 2018; 45(5):e1900. doi: 10.1590/0100-6991e-20181900. doi: 10.1590/0100-6991e-20181900 pmid: 30365692
90.	Raphael J, Mazer CD, Subramani S, et al. Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients. Anesth Analg 2019; 129(5):1209-21. doi: 10.1213/ANE.0000000000004355. doi: 10.1213/ANE.0000000000004355 pmid: 31613811
91.	Mueller MM, Van Remoortel H, Meybohm P, et al. Patient Blood Management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA 2019; 321(10):983-97. doi: 10.1001/jama.2019.0554. doi: 10.1001/jama.2019.0554 pmid: 30860564
92.	Boer C, Meesters MI, Milojevic M, et al. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA). 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth 2018; 32(1):88-120. doi: 10.1053/j.jvca.2017.06.026. doi: S1053-0770(17)30552-9 pmid: 29029990
93.	Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83(<W>5 Suppl):S27-S86. doi: 10.1016/j.athoracsur.2007.02.099. doi: 10.1016/j.athoracsur.2007.02.099
94.	Carson JL, Stanworth SJ, Roubinian N, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2016; 10(10):CD002042. doi: 10.1002/14651858.CD002042.pub4. doi: 10.1002/14651858.CD002042.pub4
95.	Cholette JM, Willems A, Valentine SL, et al. Recommendations on RBC transfusion in infants and children with acquired and congenital heart disease from the pediatric critical care transfusion and anemia expertise initiative. Pediatr Crit Care Med 2018; 19(9S Suppl 1):S137-48. doi: 10.1097/PCC.0000000000001603. doi: 10.1097/PCC.0000000000001603
96.	Dunning J, Versteegh M, Fabbri A, et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008; 34(1):73-92. doi: 10.1016/j.ejcts.2008.02.024. doi: 10.1016/j.ejcts.2008.02.024
97.	Erdoes G, Martinez Lopez De Arroyabe B, Bolliger D, et al. International consensus statement on the peri-operative management of direct oral anticoagulants in cardiac surgery. Anaesthesia 2018; 73(12):1535-45. doi: 10.1111/anae.14425. doi: 10.1111/anae.14425 pmid: 30259961
98.	Hu SS, Ji HW, Sun HS, et al. Chinese expert consensus statement on patient blood management in patients undergoing cardiovascular surgery. Chin J Blood Transfusion 2018; 31(4):321-5. doi: 10.13303/j.cjbt.issn.1004-549x.2018.04.001. doi: 10.13303/j.cjbt.issn.1004-549x.2018.04.001
99.	Chinese Society of Cardiothoracic and Vascular Anesthesiology. Perioperative Blood Management in Cardiovascular Surgery—Guidelines for Antifibrinolytic Therapy. J Clin Anesth 2016; 32(11):1137-40.
100.	Chinese Society of Anesthesiology. Guidelines for perioperative fluid and blood transfusion management in pediatric patients. Practical J Organ Transplant 2015; 3(6):328-32. doi: 10.3969/j.issn.2095-5332.2015.06.002. doi: 10.3969/j.issn.2095-5332.2015.06.002

Items	Initial heparin dose (U/kg)	Target ACT (s)	Target APTT (s)
On-pump CVS	400	≥ 410	-
OPCAB	200	≥ 300	-
Hybrid coronary revascularization	100-120 for OPCAB, 100 for PCI	≥ 300 for OPCAB, ≥ 200 for PCI	-
TAVR	100	250-350	-
TTE/TEE-guided transcatheter procedures
PDA occlusion	0	-	-
PFO/ASD/VSD closure	80―100	> 250	-
LAA occlusion	80―100	> 250	-
Balloon MV/PV/AV valvuloplasty	80―100	> 250	-
TEVAR	80―100	> 250	-
CEA	100	> 250	-
Peripheral artery stenting	80―100	> 250	-
Artificial support
IABP	50―100	150―180	60―80
ECMO	50―100	120―180	60―80
CRRT	50―100	120―140	60―80

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