| The influence of perioperative coagulation status on postoperative blood loss in complex cardiac surgery: a prospective observational study. | |
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MedLine Citation:
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PMID: 20435945 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Coagulopathy leading to excessive blood loss is a serious complication of cardiac surgery. In this prospective cohort study, we measured patients' coagulation status before and after cardiopulmonary bypass (CPB) and examined their relationships with postoperative blood loss. METHODS: Patients undergoing complex cardiac surgery with CPB who did not have preexisting coagulopathy were eligible. Detailed clinical and coagulation data were prospectively collected on all patients. Coagulation testing was performed before and after CPB, and included measures of thrombin generation, clotting factor consumption and dilution, clot stabilization, and fibrinolysis. The associations of variables with post-CPB blood loss (estimated loss from CPB to intensive care unit admission and 24-hour chest tube drainage) were assessed with the Spearman rank correlation test and multivariable linear regression. RESULTS: The median blood loss among the 101 study patients was 952 mL (interquartile range, 601-1553 mL). Variables independently associated with increasing blood loss were as follows: previous sternotomies (P = 0.01), lower pre-CPB prothrombin fragment F1 + 2 levels (measure of thrombin generation; P = 0.001), lower post-CPB platelet counts (P = 0.01), larger percent decrease in fibrinogen levels (P = 0.05), and higher post-CPB soluble fibrin monomer levels (measure of thrombin activity and clot stabilization; P < 0.0001) (model R(2) = 0.43). CONCLUSIONS: In complex cardiac surgery, blood loss is directly influenced by reduced pre-CPB thrombin generation rate, increased post-CPB consumption and dilution of clotting factors, as well as inadequate post-CPB clot stabilization. This information can aid in identifying patients at high risk for excessive blood loss and testing new interventions aimed at reducing the burden of this complication. The validity and generalizability of these findings need to be assessed by other studies. |
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Authors:
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Keyvan Karkouti; Stuart A McCluskey; Summer Syed; Chris Pazaratz; Humara Poonawala; Mark A Crowther |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-04-30 |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 110 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-26 Completed Date: 2010-06-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 1533-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia, Toronto General Hospital, 200 Elizabeth St., EN3-402, Toronto, ON, Canada M5G 2C4. keyvan.karkouti@uhn.on.c |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Algorithms Blood Coagulation / physiology* Blood Coagulation Disorders / blood, etiology Cardiac Surgical Procedures* Cardiopulmonary Bypass Cohort Studies Erythrocyte Count Erythrocyte Transfusion Female Hemoglobinometry Humans Linear Models Male Middle Aged Models, Statistical Perioperative Care / methods* Plasma Platelet Transfusion Postoperative Hemorrhage / blood*, epidemiology Predictive Value of Tests Prognosis Prospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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