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Wikman A, Diedrich B, Björling K, Forsberg PO, Harstad AM, Henningsson R, Höglund P, Sköld H, Östman L, Sandgren P. Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden. Front Public Health 2023; 10:1073318. [PMID: 36743180 PMCID: PMC9894868 DOI: 10.3389/fpubh.2022.1073318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/27/2022] [Indexed: 01/21/2023] Open
Abstract
Background Balanced transfusions, including platelets, are critical for bleeding patients to maintain hemostasis. Many rural hospitals have no or limited platelet inventory, with several hours of transport time from larger hospitals. This study aimed to evaluate the feasibility of using cryopreserved platelets that can be stored for years, in remote hospitals with no or limited platelet inventory. Material and methods Three remote hospitals participated in a prospective study including adult bleeding patients where platelet transfusions were indicated. Cryopreserved platelets were prepared in a university hospital, concentrated in 10 ml, transported on dry ice, and stored at -80°C at the receiving hospital. At request, the concentrated platelet units were thawed and diluted in fresh frozen plasma. The indications, blood transfusion needs, and laboratory parameters pre- and post-transfusion, as well as logistics, such as time from request to transfusion and work efforts in preparing cryopreserved platelets, were evaluated. Results Twenty-three bleeding patients were included. Nine patients (39%) were treated for gastrointestinal bleeding, five (22%) for perioperative bleeding, and four (17%) for trauma bleeding. The transfusion needs were 4.9 ± 3.3 red blood cell units, 3.2 ± 2.3 plasma units, and 1.9 ± 2.2 platelet units, whereof cryopreserved were 1.5 ± 1.1 (mean ± SD). One patient had a mild allergic reaction. We could not show the difference in laboratory results between pre- and post-transfusion of the cryopreserved units in the bleeding patients. The mean time from the order of cryopreserved platelets to transfusion was 64 min, with a range from 25 to 180 min. Conclusion Cryopreserved platelets in remote hospitals are logistically feasible in the treatment of bleeding. The ability to have platelets in stock reduces the time to platelet transfusion in bleeding patients where the alternative often is many hours delay. Clinical effectiveness and safety previously shown in other studies are supported in this small feasibility study.
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Affiliation(s)
- Agneta Wikman
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden,*Correspondence: Agneta Wikman ✉
| | - Beatrice Diedrich
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karl Björling
- Department of Anaesthesiology and Intensive Care, Visby Hospital, Visby, Sweden
| | - Per-Olof Forsberg
- Department Laboratory Medicine, Central Hospital of Karlstad, Karlstad, Sweden
| | - Anna-Maria Harstad
- Department of Anaesthesiology and Intensive Care, Central Hospital of Karlstad, Karlstad, Sweden
| | - Ragnar Henningsson
- Department of Anaesthesiology and Intensive Care, Central Hospital of Karlstad, Karlstad, Sweden
| | - Petter Höglund
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Hans Sköld
- Department of Anaesthesiology and Intensive Care, Torsby Hospital, Torsby, Sweden
| | - Lars Östman
- Department of Anaesthesiology and Intensive Care, Visby Hospital, Visby, Sweden
| | - Per Sandgren
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Pavani M, Cerrato E, Franzè A, Colombo F, Ryan N, Durante A, Bellini B, Calcagno S, Montorfano M, Gonzalo N, Azzalini L, Escaned J, Varbella F. Grade 3 coronary artery perforations in chronic total occlusion-percutaneous coronary intervention: Mechanisms, locations, and outcomes from the G3CAP Registry. Catheter Cardiovasc Interv 2022; 100:190-198. [PMID: 35686523 DOI: 10.1002/ccd.30293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/09/2022]
Abstract
AIM The impact of Grade III coronary perforations (G3-CP) in the setting of CTO-PCI is not well assessed. METHODS AND RESULTS We reviewed 7773 CTO-PCI and 98,819 non CTO-PCI performed in 10 European centers: G3 perforation occurred in 87 patients (1.1%) during CTO PCI and 224 patients (0.22%) during non CTO-PCI (p < 0.001). G3-CP involved the CTO segment in 68% of patients and the retrograde channels in 14% of cases. In the CTO PCI group, wire induced G3-CP (50.5% vs. 32.5%, p = 0.02) occurred predominantly when dedicated CTO tapered and highly penetrative wires were used. Intra-procedural and in-hospital death rates were 4.6% vs. 5.8% and 3.6% vs. 7.5% respectively for CTO PCI and non-CTO PCI groups (p = NS). At a median follow up of 24 months, the overall mortality and MAE were respectively 7.8% and MAE 19% without difference among groups. CONCLUSIONS We showed similar in-hospital and long-term outcomes when G3 perforations occurred during CTO PCI and non CTO-PCI.
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Affiliation(s)
- Marco Pavani
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Enrico Cerrato
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Alfonso Franzè
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Nicola Ryan
- Department of Cardiology, Aberdeeen Royal Infirmary, Aberdeen, Scotland
| | | | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Simone Calcagno
- Cardiology Department, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Nieves Gonzalo
- Cardiologia Interventionista, Hospital Clinico San Carlos, Madrid, Spain
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Javier Escaned
- Cardiologia Interventionista, Hospital Clinico San Carlos, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Unit, Infermi Hospital, Rivoli, Turin, Italy.,AOU San Luigi Gonzaga, Orbassano, Turin, Italy
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De Palma R, Settergren M, Rück A, Linder R, Saleh N. Impact of percutaneous femoral arteriotomy closure using the MANTA TM device on vascular and bleeding complications after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 92:954-961. [PMID: 29575678 DOI: 10.1002/ccd.27595] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the feasibility of fully percutaneous closure using a novel collagen-based vascular closure device after transfemoral aortic valve replacement (TAVR). BACKGROUND TAVR is utilized increasingly for the treatment of severe symptomatic aortic stenosis. Vascular complications related to access and closure dominate the adverse event profile of the procedure despite progressively reducing arteriotomy caliber. The advent of a novel collagen-based device (MANTATM ) and preliminary data suggest this could be used as a routine percutaneous closure device. METHODS A prospective observational study of unselected consecutive patients undergoing TAVR in a single center. Data were collected via hospital electronic records and the SWEDEHEART registry. The primary clinical outcome was closure success and time to hemostasis. Secondary outcomes included VARC-2 defined major and minor vascular and bleeding complications within 30 days using suture-based closure with Prostar-XL within the same center. RESULTS A consecutive cohort of 346 patients underwent TAVR via the transfemoral approach. Vascular closure with MANTATM was successful in all with a mean time to hemostasis of 42 sec (SD 115.5, range 0-600). The composite of all-cause mortality and major complications related to the main access site was similar between the groups (1.1% vs 1.9%, P = .61). Major bleeding occurred less frequently with MANTA TM (1.1% vs 7.8%, P = .02). CONCLUSION The novel use of a collagen-based vascular closure device for large caliber arteriotomy is feasible in an unselected population undergoing transfemoral TAVR and appears efficacious compared to percutaneous suture-based closure. These data should prompt larger studies to evaluate efficacy and safety.
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Affiliation(s)
- Rodney De Palma
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Solna, Stockholm, Sweden
| | - Magnus Settergren
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Solna, Stockholm, Sweden
| | - Andreas Rück
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Solna, Stockholm, Sweden
| | - Rikard Linder
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Solna, Stockholm, Sweden
| | - Nawzad Saleh
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Solna, Stockholm, Sweden
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