IJCS | Volume 32, Nº6, November / December 2019

569 Table 2 - Intraoperative data in transfused and non-transfused patients Variable Non-transfused (N = 171) Mean ± SD or N (%) Transfused (N = 100) Mean ± SD or N (%) p-value Urgency or emergency surgery 58 (34%) 61 (61%) < 0.001 Combined surgery 23 (13.5%) 24 (24%) 0.003 Procedure Coronary artery bypass grafting 99 (58%) 45 (45%) 0.124 Aortic surgery 11 (6.5%) 13 (13%) 0.110 Valve surgery 64 (37.5%) 47 (47%) 0.168 Cardiopulmonary bypass time (min) 70 ± 22 104 ± 42 < 0.001 Cross-clamp time (min) 54 ± 22 87 ± 56 < 0.001 Transoperative bleeding (mL) 256 ± 153 562 ± 527 < 0.001 SD: standard deviation; independent samples t-test for continuous variables and chi-square test for categorical variables. Table 3 - Types of transfusion (n = 271) by the time they were performed (transoperative or during intensive care) Red blood cell Platelets Fresh frozen plasma Fibrinogen Prothrombin complex Transoperative N (%) 62 (23%) 56 (20%) 32 (11.8%) 12 (4.4%) 9 (3.3%) During the intensive care unit stay N (%) 32 (12%) 10 (3.7%) 18 (6.6%) - - Tagliari et al. Blood transfusion in cardiovascular surgery Int J Cardiovasc Sci. 2019;32(6):565-572 Original Article threshold based on patients’ physiological needs, achievement of patients’ normothermia at the end of the procedure, avoidance of surgeries within 5 to 7 days of the clopidogrel use, performance of prompt coagulation testing to reduce delays in the diagnosis of reversible causes of bleeding. 7 A recent review article by Patel and Murphy 20 reinforces the idea that transfusion decision should not be solely based on hemoglobin concentration. The authors report, as potential physiologic triggers, a mean arterial pressure < 60 mmHg (or < 70-80% of baseline), heart rate > 110-130 beats/min (or > 120-130% of baseline), new ST-segment depression or elevation of at least 0.1 mV in an electrocardiogram, new wall motion abnormality on transesophageal or transthoracic echocardiography, mixed venous oxygen partial pressure < 32mmHg, oxygen extraction ratio > 40%, mixed venous oxygen saturation < 60%, or > 10% decrease in oxygen consumption (VO 2 ). 20 Nowadays, thromboelastography (TEG) and thromboelastometry (ROTEM ® ) have been considered of great value in cardiac surgery. Kozek et al., 21 reported that TEG or ROTEM-guided hemostatic therapy reduces the number of patients requiring RBC, FFP and platelet transfusions, providing a more restrictive strategy than that based on conventional laboratory testing. 21 The present study has some limitations. This study aimed to report the rates and outcomes of transfusion in daily practice, in a real-life scenario, in which we are challenged by cases not always supported by guidelines’ recommendations. Also, there are limitations intrinsic to cohort studies such as its observational nature, in addition to the fact that this was a single-center experience. Conclusion EuroScore II, chronic kidney disease, major transoperative bleeding, preoperative hemoglobin and