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[Coagulation deficits and hemorrhagic consequences after cardiac surgery under ECC].
Annales De L'Anesthesiologie Francaise
|January 1, 1977
Summary
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.