Abstract

GOUVEIA, Ricardo et al. Role of transfusion in carotid endarterectomy: A need of change in the protocol. Angiol Cir Vasc [online]. 2014, vol.10, n.3, pp.141-145. ISSN 1646-706X.

Introdution: The carotid endarterectomy is a highly differentiated procedure, with a clear known benefit, although it envolves the risk of stroke. The bleeding risk related to the surgery is low. In our departpment we routinely ask for two red blood cell units, which seems excessive. In one hand there is the risk of bleeding related to any surgery, on the other, there is a growing need to review and end unnecessary expenses because of the socio-economic crisis we live in. Methods: We retrospectively reviewed our experience in carotid endarterectomy between January 2010 and December 2012. We noted the number of red blood cell transfusions were made perioperatively. We characterized the population, as well as a number of risk factos that would be related to increased bleeding and thus transfusion risk as in hypocoagulation, known coagulophy, anemia or thombocytemia. We characterized the procedure it self as in used technique, the need for shunt, operative time, the bleeding ocurred perioperatively as in other procedural complications as cervical hematoma. Results and Conclusions: Sixty six patients were submited to carotid endarterectomy during the time of study. Two patients (3%) did need a red blood cell transfusion (two units). One case of bleeding throught the incision plus Mallory-Weiss lesions with bleeding in a hypocogulated patient. The other case of bleeding throught the incision in a already anemic patient with a coronary artery disease (postoperatively with hemoglobin of 8.1 g/dL). The mean value of bleeding was 138.70 ± 78.82 ml. Only one patient did need reinterverntion because of a cervical hematoma. These results suggest that there could be changes to make in our way of preparing for bleeding risk perioperatively in carotid endarterectomy. We can conclude that there is no need for routinely asking for two red blood cell units and can do that in selected cases. Asking for a Type and Screen routine may be enough for most situations. © 2014 Sociedade Portuguesa de Angiologia e Cirurgia Vascular. Published by Elsevier España, S.L.U. All rights reserved.

Keywords : Carotid endarterectomy; Erythrocyte transfusion; Cost savings.

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