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[Coagulation deficits and hemorrhagic consequences after cardiac surgery under ECC]
Insights
Major cardiac surgery impacts hemostasis, causing drops in platelet function and fibrin stabilizing factor (Factor XIII). These changes, along with heparin rebound, can lead to post-operative bleeding in patients undergoing extracorporeal circulation.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Coagulation Science
Context:
- Extracorporeal circulation (ECC) is a critical component of major cardiac surgery.
- Patients undergoing these procedures often exhibit complex pre-existing conditions like congenital cardiopathies, valvulopathies, or coronaritis.
- Hemostasis testing is vital for managing potential complications.
Purpose:
- To statistically analyze hemostasis test results in patients after major cardiac surgery with ECC.
- To identify specific hemostatic factor changes and their correlation with post-operative bleeding.
- To investigate the causes of hemorrhage in 5-6% of cases following cardiac surgery.
Summary:
- A statistical study evaluated hemostasis parameters (platelets, fibrinogen, prothrombin, etc.) before, during, and after ECC in 2,051 cardiac surgery patients.
- Significant findings include decreased platelet stickiness and a drop in fibrin stabilizing factor (Factor XIII) post-ECC.
- Reduced antithrombin III levels followed by a rise may contribute to heparin rebound, a potential cause of bleeding.
Impact:
- Identifies specific hemostatic deficits, such as reduced platelet function and Factor XIII, that can explain persistent hemorrhages after cardiac surgery.
- Highlights the role of antithrombin III fluctuations in heparin rebound, a significant post-operative complication.
- Provides insights into the multifactorial causes of bleeding after cardiac surgery, including coagulation factor deficits, DIC, and fibrinolysis.
Abstract:
I--A statistical study of the results of tests of hemostasis was carried out in patients who had undergone major cardiac surgery with extra-corporeal circulation. There were two series of patients (1.504 and 547 operated) suffering mainly from congenital cardiopathies, valvulopathies or coronaritis. Bearing in mind the hematocrit and the total protein level, the following was studied before and after ECC and 24 hours after the intervation: the blood platelet level, fibrinogen, prothrombin and its cofactors, antithemophilic factors A and B, FDP amd fibrinolytic activity. The fall in platelet stickiness is specifically pointed out, and also the fall in the level of fibrin stablizing factor (factor XIII) which is met with after ECC, and which can explain the persistence of certain hemorrhagies. Furthermore, the fall in antithrombin III level then its rise can contribute to the "heparine rebound" occurring in certain cases after neutralization of heparinemia with protamine. II--The deficits in the quantitatively and qualitatively variable hemostatic factors do not necessarily lead to hemorrhage. Hemorrhage, due to biological causes, are met with in 5 to 6 p. 100 of the cases. Most of the time they are provoked by a residual hemorrhage or a "heparine rebound", deficits in coagulation factors, a DIVC syndrome, difficult to diagnose and to treat, or fibrinolysis, much more rarely nowadays, owing to the almost routine use of antiproteases. Sometimes, the check up of coagulation can be barely disturbed and local abnormalities in biological hemostasis which are still not well understood, are invoked in order to explain the hemorrhage.