PB1069 - Perioperative Management of Major Bleeding: A Survey of Treatment Practices from Members of the American Society of Anesthesiology

Background: Multimodal strategies are used to manage perioperative bleeding, in particular for cardiac surgery, liver surgery, and post-partum hemorrhage (PPH). In the United States (US), transfusion of allogeneic blood products including fresh frozen plasma (FFP) and cryoprecipitate are the mainstay of bleeding management for acquired factor deficiency, yet the use of factor concentrates to support or supplement transfusion has been increasingly adopted with blood supply shortages.

Aims: Our goal was to identify current practices for major bleeding management in perioperative surgical patients in the US.

Methods: A 22-question survey was sent to American Society of Anesthesiology members. Invitations to the online survey were emailed bi-weekly from 06/7/2023 to 08/11/2023 (10 weeks) and responses were collected using SurveyMonkey.

Results: Responses were received from 1,014 anesthesiologists. Figure 1 details treatment choice responses for cardiac surgery, liver surgery, and PPH. Respondents indicated FFP was their primary treatment choice for managing major bleeding in cardiac surgery (41.8%), liver surgery (46.8%), and PPH (51.8%). In cardiac surgery, prothrombin complex concentrate (PCC) use, including 3-factor, 4-factor, and activated PCCs, was used by 41.3% of respondents. Recombinant factor VIIa use was 14.8% in cardiac surgery, 12.0% in liver surgery, and 11.6% in PPH. Figure 2 displays the proportion of respondents that would use fibrinogen concentrate over cryoprecipitate for bleeding management in cardiac surgery (42.6%), liver surgery (28.4%), and PPH (37.4%).

Conclusion(s): Although FFP is commonly used to manage perioperative bleeding, factor concentrates, including PCCs and fibrinogen, are important alternative/adjunctive modalities. Despite US labeling, factor concentrates represent therapeutic options for perioperative bleeding management with ongoing allogeneic blood product shortages due to their immediate availability, lack of cross-matching requirement, and room temperature storage. Further studies are needed to determine their efficacy and role in perioperative bleeding management.