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This meta-analysis was designed to evaluate the effects of tranexamic acid (TXA) on platelets in patients undergoing cardiac surgery (CS). Relevant trials were identified by computerized searches of PUBMED, Cochrane Library, EMBASE, OVID, China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data till Jun 4th, 2022, were searched using search terms "platelet", "Tranexamic acid", "cardiac surgery", "randomized controlled trial" database search was updated on Jan 1st 2023. Primary outcomes included platelet counts, function and platelet membrane proteins. Secondary outcome included postoperative bleeding. Search yielded 49 eligible trials, which were finally included in the current study. As compared to Control, TXA did not influence post-operative platelet counts in adult patients undergoing on- or off-pump CS, but significantly increased post-operative platelet counts in pediatric patients undergoing on-pump CS [(WMD = 16.72; 95% CI 6.33 to 27.10; P = 0.002)], significantly increased post-operative platelet counts in adults valvular surgery [(WMD = 14.24; 95% CI 1.36 to 27.12; P = 0.03). Additionally, TXA improved ADP-stimulated platelet aggression [(WMD = 1.88; 95% CI 0.93 to 2.83; P = 0.0001)] and improved CD63 expression on platelets [(WMD = 0.72; 95% CI 0.29 to 1.15; P = 0.001)]. The current study demonstrated that TXA administration did not affect post-operative platelet counts in adult patients undergoing either on- or off-pump CABG, but significantly increased post-operative platelet counts in pediatric patients undergoing on-pump CS and adults valvular surgery. Furthermore, TXA improved ADP-stimulated platelet aggression and improved CD63 expression on platelets. To further confirm this, more well designed and adequately powered randomized trials are needed. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the present study were to establish a population pharmacokinetic (PPK) model of cefazolin for adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and to assess the probability of target attainment (PTA) for the prophylaxis of surgical site infection (SSI) using cefazolin. Methods: Adult patients who underwent cardiac surgery with CPB were enrolled in the prospective study. Blood samples for plasma cefazolin assay were collected, and total and unbound drug concentrations were measured and analysed using the nonlinear mixed-effects modelling (NONMEM) software considering saturable plasma protein binding. Using the PPK model, plasma unbound cefazolin concentration-time courses with current prophylaxis protocols were simulated, and the PTA for common SSI pathogens was estimated. Results: A total of 199 blood samples were obtained from 27 patients. A one-compartment model with first-order elimination plus an on/off CPB compartment best described the data. The population mean for systemic drug clearance (CL) was reduced and that for the volume of distribution (V) was increased during CPB compared with the pre-CPB values. CPB-induced hypoalbuminemia was associated with reduced maximum protein binding (Bmax). The simulation studies suggested that the current dosing protocols are insufficient for attaining PTA > 0.9 throughout surgery against pathogens with minimum inhibitory concentrations (MICs) >8 mg/L. A new dosing protocol that achieves a PTA > 0.9 for pathogens with a MIC of 16 mg/L was proposed. Conclusion: PPK modelling with simulation may be valuable for devising a cefazolin prophylaxis protocol for patients undergoing cardiac surgery with CPB. [ABSTRACT FROM AUTHOR]

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Cardiac surgery has been evolving to include minimally invasive, hybrid and transcatheter techniques. Increasing patient age and medical complexity means that critical care management needs to adapt and evolve. Recent advances have occurred in several areas, including ventilation, haemodynamics and mechanical circulatory support, bleeding and coagulation, acute kidney injury, and neurological management. This narrative review describes standard care, recent advances, and future areas of research in the critical care management of patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Purpose: Patients undergoing cardiac surgery often require transfusions of red blood cells, plasma and platelets. These components differ widely in both indications for use and composition. However, from a statistical point of view there is a significant colinearity between the components. This study explores the relation between the transfusion of different blood components and long-term mortality. Methods: A retrospective single-centre study was performed including 5,261 coronary artery bypass grafting patients, excluding patients receiving more than eight units of red blood cells, those suffering early death (7 days) and emergency cases. Patients were followed up for a period of up to 7.5 years. A broad spectrum of potential risk factors was analysed using Cox proportional hazards survival regression. Non-significant risk factors were removed by step-wise elimination, and transfusion of red blood cells, plasma and platelets was forced to remain in the model. Results: The transfusion of red blood cells was not associated with decreased long-term mortality (HR = 1.007, p = 0.775), whereas the transfusion of plasma was associated with decreased long-term survival (HR = 1.060, p < 0.001), and the transfusion of platelets was associated with increased long-term survival (HR = 0.817, p = 0.011). The risk associated with transfusion of plasma was mainly attributed to patients receiving large amounts of plasma. All hazard ratios are per unit of blood product transfused. Conclusions: No association was found between the transfusion of red blood cells and mortality during the study period. However, transfusion of plasma was associated with increased mortality while transfusion of platelets was associated with decreased mortality during the study period. [ABSTRACT FROM AUTHOR]