Surgical Hemostasis Outcomes and Trials Team (SHOTT)

The Surgical Hemostasis Outcomes and Trials Team (SHOTT) explores mechanisms of coagulopathy in surgical and critically-ill patients.  This includes platelet dysfunction, impaired thrombin generation, and abnormalities in primary hemostasis.  We also perform outcomes research and trials related to blood transfusion, coagulation therapies, and viscoelastic coagulation testing.  Our goals are to elucidate mechanisms of coagulopathy, improve coagulation monitoring and management for patients, and to compare the efficacy of various hemostatic treatments.  Examples of projects that the lab has performed include creation of a multicenter HIT registry for cardiac surgical patients requiring CPB, a phase I study of recombinant vWF in ECMO patients, and a study of primary hemostasis in children with congenital heart disease.  The group also participated in a multicenter trial of ANH in cardiac surgical patients that was published in the NEJM.

Michael Mazzeffi, MD, MPH, MSc, FASA has been involved in coagulation research since he was a fellow under the mentorship of Drs. Jerrold Levy and Kenichi Tanaka.  In 2016 he received a Masters in Clinical Research at the University of Maryland, Baltimore.  His research has previously been funded by the Society of Cardiovascular Anesthesiology as well as industry.  He has a particular interest in ECMO-induced coagulopathy, its monitoring, and treatment.

A Randomized Trial of Acute Normovolemic Hemodilution in Cardiac Surgery. Monaco F, Lei C, Bonizzoni MA, Efremov S, Morselli F, Guarracino F, Giardina G, Arangino C, Pontillo D, Vitiello M, Belletti A, Ajello V, Licheri M, Nigro Neto C, Barucco G, Bukamal NA, Faustini C, Mantovani LF, Oriani A, Santonocito C, Mucchetti M, Federici F, Gerli C, Porta S, Scandroglio AM, Zhang H, Pieri M, Osinsky R, Lazzari S, Leonova E, Calabrò MG, Amitrano D, Turi S, Prati P, Fresilli S, D’Amico F, D’Andria Ursoleo J, Labanca R, Marmiere M, Pruna A, Scquizzato T, Kırali K, Monti G, Carmona MJC, Tanaka K, Likhvantsev V, Ti LK, Bove T, Paternoster G, Singh K, Gürcü ME, Lomivorotov V, Landoni G, Bellomo R, Zangrillo A; ANH Study Group.N Engl J Med. 2025 Jul 31;393(5):450-460. doi: 10.1056/NEJMoa2504948. Epub 2025 Jun 12.PMID: 40503713 Clinical Trial.

Acute Normovolemic Hemodilution in Adult Cardiac Surgery. Tanaka KA, Stewart KE, Vandyck KB, Burkhart HM, Garwe T, Kertai MD, Butt AL, Mazzeffi MA.JAMA Surg. 2025 Nov 1;160(11):1195-1201. doi: 10.1001/jamasurg.2025.3238.PMID: 40900582

Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis. Del Vecchio A, Pham LP, McNeil J, Singh K, Tanaka K, Eaton M, Mazzeffi M.J Cardiothorac Vasc Anesth. 2024 Dec;38(12):2915-2924. doi: 10.1053/j.jvca.2024.09.006. Epub 2024 Sep 12.PMID: 39353821

Outcomes of heparinized adult veno-arterial extracorporeal membrane oxygenation patients managed with low and high activated partial thromboplastin time targets: A systematic review and meta-analysis. Mazzeffi M, Lin D, Gonzalez-Almada A, Stombaugh DK, Curley J, Mangunta V, Teman N, Yarboro LT, Thiele R.Perfusion. 2024 Apr;39(3):525-535. doi: 10.1177/02676591221150880. Epub 2023 Jan 3.PMID: 36595340

Off-label Use of Recombinant Activated Factor VII for Cardiac Surgical Bleeding. Flynn BC, Steiner ME, Mazzeffi M.Anesthesiology. 2023 Aug 1;139(2):197-210. doi: 10.1097/ALN.0000000000004569.PMID: 37155359 No abstract available.

Recrudescent Heparin-Induced Thrombocytopenia After Therapeutic Plasma Exchange in a Patient Undergoing Thoracic Aortic Replacement. Man L, Yount K, Grazioli A, Padmanabhan A, Thiele R, Maitland HS, Mazzeffi M.J Cardiothorac Vasc Anesth. 2023 Dec;37(12):2592-2596. doi: 10.1053/j.jvca.2023.09.024. Epub 2023 Sep 21.PMID: 37827918

ABO-identical versus incompatible platelet transfusion in patients with intracranial hemorrhage. Dunn LK, Venner E, Nguyen M, Trejo JP, Holley Z, Naik BI, Khan J, Mazzeffi M.PLoS One. 2024 Nov 21;19(11):e0312602. doi: 10.1371/journal.pone.0312602. eCollection 2024.PMID: 39570940

Platelet P2Y12 Receptor Inhibition and Perioperative Patient Management. Mazzeffi M, Tanaka KA, Gurbel PA, Tantry US, Levy JH.Anesthesiology. 2025 Jan 1;142(1):202-216. doi: 10.1097/ALN.0000000000005148.PMID: 39392789

Iatrogenic blood loss from phlebotomy during adult extracorporeal membrane oxygenation: A retrospective cohort study. Mazzeffi M, Miller D, Wang A, Kothandaraman V, Money D, Clouse B, Zaaqoq AM, Teman N.Transfusion. 2024 Mar;64(3):475-482. doi: 10.1111/trf.17729. Epub 2024 Feb 22.PMID: 38385665

Pilot Assessment of Platelet Thrombus Area and Contractile Force in Pediatric Congenital Heart Surgery Patients Using a Microfluidic Device. Wisniewski A, Norman A, Tsang S, Ricketts R, Sharma R, Suggs J, Vizzini S, Castro B, Raphael J, McNaull P, Gangemi J, Roeser M, Mazzeffi M.J Cardiothorac Vasc Anesth. 2024 Sep;38(9):2009-2016. doi: 10.1053/j.jvca.2024.06.017. Epub 2024 Jun 17.PMID: 38960807

Trends in the Use of Recombinant Activated Factor VII and Prothrombin Complex Concentrate in Heart Transplant Patients in Virginia. Mazzeffi M, Beller J, Strobel R, Norman A, Wisniewski A, Smith J, Fonner CE, McNeil J, Speir A, Singh R, Tang D, Quader M, Yarboro L, Teman N.J Cardiothorac Vasc Anesth. 2024 Mar;38(3):660-666. doi: 10.1053/j.jvca.2023.10.003. Epub 2023 Oct 4.PMID: 38220518

Getting Ahead of the Clot: Precision Medicine and Prediction of Perioperative Venous Thromboembolism. Forkin KT, Naik BI, Mazzeffi MA.Anesthesiology. 2025 Jul 1;143(1):12-14. doi: 10.1097/ALN.0000000000005516. Epub 2025 Jun 10.PMID: 40492795

Questions About Strategies and Dosing Levels of PCC for Coagulopathic Bleeding in Cardiac Surgery. Mazzeffi M, Henderson R.JAMA. 2025 Sep 2;334(9):831. doi: 10.1001/jama.2025.8991.PMID: 40720141

Thrombin, tissue factor pathway inhibitor, and von Willebrand factor: unmasking the coagulopathy of veno-venous extracorporeal membrane oxygenation. Mazzeffi M, Tanaka KA, Levy JH.J Thromb Haemost. 2025 Dec;23(12):3798-3801. doi: 10.1016/j.jtha.2025.09.001.PMID: 41260736

Prophylactic von Willebrand factor replacement in durable left ventricular assist device patients: a sticky subject. Mazzeffi M, Levy JH, Tanaka K.J Thromb Haemost. 2026 Feb;24(2):378-380. doi: 10.1016/j.jtha.2025.10.023.PMID: 41644236

Single-Center Experience with Sonic Estimation of Elasticity via Resonance (SEER)-Guided Hemostasis in Adult Cardiac Surgical Patients. Mazzeffi M, Khan J, McNeil J, Zvara J, Walters S, Kleiman A, Gallo P, Roach J, Thiele R, Stombaugh DK, Mehta S, Floyd T, Yarboro L, Beller J, Kern J, Singh K.J Cardiothorac Vasc Anesth. 2026 Jan;40(1):31-37. doi: 10.1053/j.jvca.2025.09.031. Epub 2025 Sep 19.PMID: 41087257