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Sonoclot analysis in cardiac surgery in dialysis-dependent patients
Toshihiko Shibata1, Yasuyuki Sasaki, Koji Hattori
1Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan. shibata@msic.med.osaka-cu.ac.jp
Background:
Dialysis-dependent patients have multiple disorders of hemostasis; however, there are no reports of viscoelastic changes during cardiac surgery in such patients.
Methods:
Hemostasis in dialysis-dependent patients during cardiac operations was evaluated. Thirty patients who underwent cardiopulmonary bypass (CPB) were studied: 6 with chronic renal failure undergoing dialysis (HD group), and 24 without hemodialysis. Blood samples were obtained at four points: before sternotomy, 30 and 90 minutes after the start of CPB, and after protamine administration.
Results:
Activated clotting time (ACT) measured with Sonoclot analyzer was significantly correlated with ACT measured traditionally (r = 0.92; p < 0.001; y = 36.1 + 0.95x). Values for ACT measured with Sonoclot analyzer as well as traditional ACT increased significantly during CPB. Values for ACT measured with Sonoclot analyzer in the HD group were significantly longer than those in the control group. Before CPB, both ACT measured with Sonoclot analyzer and traditional ACT in the HD group were significantly longer than those in the control group; however, there were no significant differences in ACT measured with Sonoclot analyzer between the groups after CPB. Clot rates and peak signal values were significantly decreased during CPB in both groups, and returned to preoperative values after protamine administration. There were no significant differences in clot rate and peak signal values between the two groups. There were no differences between the two groups in changes of time to peak. Platelet counts in the HD group were significantly higher (p < 0.05) than those in the control group. There were no differences in platelet counts after CPB between the two groups. Antithrombin III levels decreased below 50% during and after CPB. Antithrombin III in the HD group was significantly lower (p < 0.01) than those in the control group. A significant time-group interaction was observed in antithrombin III levels.
Conclusions:
Sonoclot signatures in HD patients showed no significant differences in viscoelastic changes compared with non-HD patients.