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Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery
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Fibrinolysis is a physiologic component of hemostasis that functions to limit clot formation. However, after trauma or surgery, excessive fibrinolysis may contribute to coagulopathy, bleeding, and inflammatory responses. Antifibrinolytic agents are increasingly used to reduce bleeding, allogeneic blood administration, and adverse clinical outcomes. Tranexamic acid is the agent most extensively studied and used in most countries. This review will explore the role of fibrinolysis as a pathologic mechanism, review the different pharmacologic agents used to inhibit fibrinolysis, and focus on the role of tranexamic acid as a therapeutic agent to reduce bleeding in patients after surgery and trauma.
CME Credit: 1.00 AMA PRA Category 1 Credit™
Required Hardware / Software:Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.
Activity Release Date:02/13/2018
Activity Expiration Date:02/12/2021
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Learning Objectives: After successfully completing this activity, the learner will be able to:
- Explain the effects of plasminogen and plasmin on fibrinolysis and inflammatory response - Evaluate the benefit of antifibrinolytics in a specific patient population - Recognize the risk of...
- Explain the effects of plasminogen and plasmin on fibrinolysis and inflammatory response - Evaluate the benefit of antifibrinolytics in a specific patient population - Recognize the risk of seizure activity with administration of tranexamic acid - Evaluate the risk of hypercoagulable state in patients receiving antifibrinolytics
Editor-in-Chief: Evan D. Kharasch, M.D., Ph.D., has reported receiving consulting fees from TEN Healthcare.
CME Editors: Leslie C. Jameson, M.D. has reported no relevant financial relationships with commercial interests. Dan J. Kopacz, M.D., has reported holding an equity position with SoloDex, LLC.
Authors: Jerrold H. Levy, M.D., F.A.H.A., F.C.C.M.; Andreas Koster, M.D.; Quintin J. Quinones, M.D., Ph.D., report no relevant financial relationships with commercial interests. Truman J. Milling, M.D., reports receiving grant funding from CSL Behring, Boehringer Ingelheim, NHLBI, Janssen, and Octapharma. Nigel S. Key, M.B., Ch.B., F.R.C.P., received grant funding from Shire, Inc., and receives consulting fees from Novo Nordisk, Genentech/Roche, and CSL.
ASA Staff: Kari L. Lee, Senior Managing Editor, has reported no relevant financial relationships with commercial interests. Ginger Clark, Senior Editor, has an equity position in Merck & Co.
Disclosure Statement: The American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.
Disclaimer: The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Core Competencies: Medical knowledge
Target Audience: ANESTHESIOLOGY Journal CME is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should
claim only the credit commensurate with the extent of their participation in the activity.
1.00 Non-physician Credit Non-physicians may receive a Certificate of Completion stating that this activity was designated for 1.00 AMA PRA Category 1 Credit(s)™.
Activity Release Date: 2/13/2018 Activity Expiration Date: 2/12/2021
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