Document Detail


Decreased von Willebrand factor ristocetin cofactor activity and increased ADAMTS13 antigen increase postoperative drainage after coronary artery bypass grafting.
MedLine Citation:
PMID:  24351199     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Routine coagulation tests and bleed-scores fail to identify patients at risk of excessive postoperative drainage following coronary artery bypass grafting (CABG). We sought to investigate whether lower von Willebrand factor (VWF) and higher ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) are associated with a high postoperative drainage after CABG.
METHODS: In the prospective cohort study, VWF antigen (VWF:Ag), VWF ristocetin cofactor (VWF:RCO), VWF collagen-binding (VWF:CB), ADAMTS13 antigen (ADAMTS13:Ag) and ADAMTS13 activity were measured on the day of elective on-pump CABG in 232 consecutive patients without a prior history of haemorrhagic diathesis, including von Willebrand disease (95% discontinued aspirin preoperatively). Postoperative drainage and blood product use were recorded.
RESULTS: A comparison of extreme drainage quartiles (n = 56) showed that individuals with the highest drainage volumes have mean VWF:RCO lower by 19% (P < 0.0001), median VWF:Ag lower by 19% (P < 0.0001), ADAMTS13:Ag higher by 8% (P = 0.0002), ADAMTS13 activity higher by 9% (P = 0.01) and fibrinogen lower by 14% (P = 0.03) than those with the lowest drainage. Linear regression analysis showed that preoperative VWF:RCO (b = -4.83, P = 0.002) and fibrinogen (b = -61.52, P = 0.04) are the only independent predictors of postoperative drainage. Multivariate logistic regression demonstrated that preoperative VWF:RCO in the lowest quartile and ADAMTS13:Ag levels in the highest quartile increased the risk of high (≥1000 ml) drainage (odds ratio [95% confidence interval] = 4.88 [1.83-13.02], P = 0.001 and 3.77 [1.49-9.52], P = 0.005; respectively).
CONCLUSIONS: Patients undergoing elective CABG with lower preoperative VWF:RCO are at risk of having larger postoperative drainage, which suggests a novel contributor to increased perioperative bleeding in cardiac surgery.
Authors:
Piotr Mazur; Dariusz Plicner; Joanna Zdziarska; Jerzy Sadowski; Anetta Undas
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-17
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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