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- May 2, 2011
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Anyone ever use this? Anyone know how much it costs?
I have only used it for hemophiliacs. I don't see much use for it otherwise. I don't tend to transfuse for coagulopathy unless bypass time is over 4 hrs. By then I think I need more than the 3 or 4 factors in the complex.
For the young bucks, don't ever say on your oral board that you are giving ffp for volume. The ASA is opposed to this practice.
I get it. Just pointing out that for the boards it is better not to mention ffp and volume in the same sentence.Guess I should clarify. If the patient is coagulopathic and hypovolemic post pump I will use FFP. If they are coagulopathic and already volume overloaded I will consider PCC.
I probably wouldn't bother with 3 factor PCCs (i.e. Bebulin) unless the apocalypse hit and the blood bank was out of FFP. 4 factor PCCs will make sense once we get them, though cost will probably be prohibitive for routine use.
Tangentially, we're getting a ROTEM soon, which I'm happy about.
Even more tangentially, I had recently asked the hospital to supply IV fibrinogen (RiaSTAP) and was shot down for cost reasons. I pointed out the numerous instances where we were hypofibrinogenemic and the blood bank took forever to get us cryo, but they didn't seem to care. Bastards.
It's such a shame that Europe is years ahead of us in terms of using these products.
That said, it's now a minority of our patients that get transfused at all, so we're making good progress regardless.
TEG/Rotem don't correlate with bleeding in my experience. You can have a good teg/bleeding as well as bad teg/no bleeding and every random combination you can imagine.Can you elaborate?
Give it a try and arrive at your own conclusions. Report back in a few months.Interesting. Thanks. Will take things with a grain of salt.