Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF March 25, 2016 | Archived Issues

FDA Warns About Zydelig

Pharmacy Focus

The U.S. Food and Drug Administration is alerting healthcare professionals about reports of an increased rate of adverse events, including deaths, in clinical trials with the cancer medicine Zydelig in combination with other cancer medicines.

» Read more


Meetings and Events


Grand Rounds

Click here to view upcoming grand rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - March 2016 (PDF)  


Milestones

Morton W. Klein, MD, has died.

» Read more

Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

Click here to share your news

Transfusion Guidelines Aim for Less PCI Bleeding

Bleeding complications pose significant risks to patient safety and quality of care. Reducing bleeding related to percutaneous coronary intervention (PCI) from 5.9 percent to 3.8 percent is an institutional priority and a Quality Council goal for this year, and we need your help to achieve it.

There are five categories of post-PCI bleeding events, one of which is "Post-PCI transfusion for patients with a pre-procedure HgB > 8 g/dL within 30 days post-procedure." To reduce the number of inappropriate post-PCI blood transfusions, the Cedars-Sinai red blood cell transfusion guidelines from 2012 have been amended as follows.

Consider post-PCI blood transfusion only if:

  • Hematocrit ≤ 21 percent or hemoglobin ≤ 7g/dL in
  • Patients with stable, nonactive coronary artery disease (CAD)
  • Patients with revascularized nonactive CAD (including post-PCI patients if revascularization has occurred)
  • Hematocrit < 24 percent or hemoglobin < 8g/dL in
  • Patients with unrevascularized symptomatic CAD, with evidence of ischemia
  • Please note that patients with symptomatic CAD should receive blood prior to PCI, rather than after intervention, with a goal of hemoglobin > 8g/dL
  • These guidelines do not apply in areas where there is active bleeding or the anticipation of significant blood loss, such as operating rooms, procedure rooms, labor and delivery, and chemotherapy.
  • Threshold numbers do not mandate transfusion, and clinical judgment should guide the use of products in otherwise stable patients.

These guidelines are posted on the Intranet under Clinical Resources.

A Best Practices Alert will pop up in CS-Link when a blood transfusion is ordered for a PCI patient who falls outside the guidelines. This is an attempt to make physicians consider whether the blood transfusion is indicated. Please don't simply click on active blood loss just to bypass the order, but take the time to think about the indications.

Post-PCI blood transfusions are monitored daily by the Blood Bank, and any transfusion that falls outside of guidelines will be subject to clinical chart review by cardiologists to determine its appropriateness. Transfusion orders deemed inappropriate will be followed up with a conversation between the ordering physician and reviewers from Cardiology.

On behalf of the Department of Medicine and Division of Cardiology, thank you in advance for your collaboration in this important hospitalwide effort to assure the best standard of care for our patients. If you have questions, please contact Steven Tabak, MD, medical director for Quality and Physician Outreach at the Cedars-Sinai Heart Institute.