Abstract
BackgroundCoagulopathy and following massive bleeding are complications of cardiovascular surgery, particularly occurring after procedures requiring prolonged cardiopulmonary bypass (CPB). Reliable and rapid tests for coagulopathy are desirable for guiding transfusion. Measuring multiple coagulation parameters may prove useful. The purpose of this study is to determine the laboratory parameters predicting massive bleeding.MethodsIn a prospectively collected cohort of 48 patients undergoing cardiovascular surgery, markers of coagulation and fibrinolysis were measured using automated analyzer and their correlations with bleeding volume were determined.ResultsOperation time was 318 (107–654) min. CPB time was 181 (58–501) min. Bleeding volume during surgery was 2269 (174–10,607) ml. Number of transfusion units during surgery were packed red blood cells 12 (0–30) units, fresh frozen plasma 12 (0–44) units, platelets 20 (0–60) units and intraoperative autologous blood collection 669 (0–4439) ml. Post-surgery activities of coagulation factors II (FII), FV, FVII, FVIII, FIX, FX, FXI and FXII were decreased. Values of fibrinogen, antithrombin, α2 plasmin inhibitor (α2PI) and FXIII were also decreased. Values of thrombin-antithrombin complex (TAT) were increased. Values of FII, FIX, FXI and α2PI before surgery were negatively correlated with bleeding volume (FII, r = − 0.506: FIX, r = − 0.504: FXI, r = − 0.580; α2PI, r = − 0.418). Level of FIX after surgery was negatively correlated with bleeding volume (r = − 0.445) and level of TAT after surgery was positively correlated with bleeding volume (r = 0.443).ConclusionsThese results suggest that several clinical and routine laboratory parameters of coagulation were individually associated with bleeding volume during cardiovascular surgery. Determining the patterns of coagulopathy may potentially help guide transfusion during cardiovascular surgery.
Highlights
Coagulopathy and following massive bleeding are complications of cardiovascular surgery, occurring after procedures requiring prolonged cardiopulmonary bypass (CPB)
Study design and subjects In a prospectively collected cohort of patients undergoing cardiovascular surgery at Asahikawa Medical University Hospital (Asahikawa, Japan) from November 2015 to March 2016, we examined the association between coagulation parameters and bleeding volume
Activities of coagulation factors (Fig. 1B) and values of FXIII, ATIII and α2 plasmin inhibitor (α2PI) were decreased and values of thrombinantithrombin complex (TAT) were increased at point 2 (Fig. 1C)
Summary
Coagulopathy and following massive bleeding are complications of cardiovascular surgery, occurring after procedures requiring prolonged cardiopulmonary bypass (CPB). The purpose of this study is to determine the laboratory parameters predicting massive bleeding. Coagulopathy and massive bleeding are severe complications of cardiovascular surgery, occurring after procedures requiring prolonged cardiopulmonary bypass (CPB) [1, 2]. Reliable and predictive laboratory tests on coagulation function may help guide clinicians to appropriate transfusion and may decrease variabilities in transfusion practices. Appropriate coagulation parameters would help to predict bleeding after cardiovascular surgery. Such knowledge could potentially enable clinicians to effectively treat coagulopathy after surgery requiring CPB. Markers of coagulation and fibrinolysis were measured during cardiovascular surgery and their correlations with bleeding volume were determined
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