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Correlation between thrombin potential and bleeding after cardiac surgery in adults
Simon J Davidson1, John F Burman, Sophia M Philips
1Departments of Haematology, Anaesthetics and Surgery, Royal Brompton Hospital, London, UK. s.davison@rbh.nthames.nhs.uk
Summary
Reduced thrombin generation after coronary artery bypass graft surgery correlates with increased blood loss. This finding highlights the importance of monitoring thrombin potential in patients undergoing cardiopulmonary bypass.
Area of Science:
- Biochemistry
- Cardiovascular Surgery
- Hematology
Background:
- Cardiopulmonary bypass (CPB) surgery for coronary artery bypass grafts (CABG) can lead to significant blood loss.
- Thrombin generation, a key process in hemostasis, may be altered during CPB.
- Understanding factors influencing hemostasis is crucial for managing postoperative bleeding.
Purpose of the Study:
- To measure thrombin potential in patients undergoing CABG surgery.
- To assess the correlation between thrombin potential and postoperative blood loss.
- To evaluate changes in specific coagulation factors during and after CPB.
Main Methods:
- Sensitive assay used to measure thrombin potential in 20 patients undergoing CABG.
- Coagulation factors II, V, VII, VIII, and X levels were measured preoperatively and postoperatively.
- Postoperative blood loss was quantified from mediastinal drains within the first 24 hours.
Main Results:
- Thrombin potential significantly decreased postoperatively (median 46 nmol/l.min) compared to preoperatively (median 107 nmol/l.min).
- Coagulation factors II, V, VII, and X showed significant reductions postoperatively.
- A strong inverse correlation was observed between reduced thrombin potential and total postoperative blood loss (r = -0.75).
- The decrease in thrombin potential correlated with reduced prothrombin (Factor II) and Factor X levels.
Conclusions:
- Thrombin generation is significantly impaired following CPB surgery for CABG.
- Reduced thrombin potential is a significant predictor of increased postoperative blood loss.
- Monitoring thrombin potential may offer insights into hemostatic balance and bleeding risk in these patients.