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Antithrombin after cardiac surgery: implications on short and mid-term outcome
Domenico Paparella1, Giangiuseppe Cappabianca, Giuseppe Scrascia
1Dipartimento di Emergenza e Trapianti di Organo (D.E.T.O.), Division of Cardiac Surgery, University of Bari, Piazza Giulio Cesare 11, Bari, 70100, Italy. dpaparella@cardiochir.uniba.it
Insights
Low Antithrombin (AT) levels after cardiac surgery correlate with increased peri-operative complications and worse mid-term survival. Monitoring postoperative AT is crucial for predicting patient outcomes.
Area of Science:
- Cardiology
- Hematology
- Surgical Outcomes
Background:
- Antithrombin (AT) levels can decrease during cardiac surgery, but the causes and consequences remain unclear.
- Understanding the impact of postoperative AT levels on patient outcomes is essential for improving cardiac surgical care.
Purpose of the Study:
- To investigate the relationship between postoperative Antithrombin (AT) levels and short-term (in-hospital) and mid-term (18-month) outcomes following cardiac surgery.
- To determine if a low Antithrombin (AT) level upon ICU arrival is a predictor of adverse events and survival.
Main Methods:
- A cohort of 405 patients undergoing cardiac surgery between January and June 2005 had their Antithrombin (AT) levels measured preoperatively and postoperatively.
- Receiver Operating Characteristic (ROC) curve analysis identified a cut-off of 63.7% for ICU-arrival AT to stratify patients into 'Low AT' (<63.7%) and 'High AT' (>=63.7%) groups.
- Outcomes assessed included in-hospital mortality, morbidity (mechanical ventilation, inotropic support, bleeding, transfusion), and 18-month survival.
Main Results:
- ICU-arrival AT levels were significantly lower than preoperative levels (71.2% vs. 90.7%, P < 0.0001).
- The 'Low AT' group (n=117) exhibited characteristics of higher surgical risk, including older age, female sex, worse Euroscore, and longer cardiopulmonary bypass and cross-clamp times.
- While not linked to in-hospital mortality, ICU-arrival AT < 63.7% independently predicted longer mechanical ventilation, increased need for inotropic support, excessive bleeding, and blood product transfusion.
- The 'Low AT' group showed significantly worse 18-month survival (85.4%) compared to the 'High AT' group (92.3%, P = 0.05).
Conclusions:
- Reduced Antithrombin (AT) levels post-cardiac surgery are associated with a higher incidence of peri-operative complications.
- Low Antithrombin (AT) levels are a significant predictor of worse mid-term survival after cardiac surgery.
- Further research is warranted to elucidate the underlying pathophysiology and explore potential therapeutic interventions for managing low AT levels.
Background:
Antithrombin (AT) drop during cardiac surgery has been described. The causes and the effects of this phenomenon are not clear. The objective of the study is to evaluate the relationship of AT postoperative values on short and mid-term outcome after cardiac surgery.
Methods:
Between January and June 2005, 405 patients, who underwent cardiac operations at our Institution had AT values available preoperatively and postoperatively. Using Receiver Operating Characteristic curves, a cut-off equal to 63.7% for ICU-arrival AT was chosen in order to divide the entire population in two groups (117 patients with ICU-arrival AT < 63.7%, Low AT group, and 288 patients with ICU-arrival AT > or = 63.7%, High AT group). Objective of the study was to evaluate the predictive role of ICU-arrival AT < 63.7% on in-hospital mortality and morbidity and on 18 months follow-up after cardiac surgery.
Results:
ICU-arrival AT was significantly lower than preoperative AT (90.7 +/- 16.3% vs. 71.2 +/- 15.1%, P < 0.0001). Patients in the Low AT group were older, more often female, had a worse Euroscore and required longer CPB duration and cross clamp time. They had significantly higher preoperative and postoperative D-dimer levels. ICU arrival AT < 63.7% was not associated with increased in-hospital mortality but it was an independent risk factor for longer mechanical ventilation, need of inotropic support, excessive bleeding and blood products transfusion. ICU arrival-AT < 63.7% was associated with worse survival during 18 months follow up (92.3% vs. 85.4% in the High AT and Low AT group, respectively, P = 0.05).
Conclusions:
Low AT after cardiac surgery is associated with higher incidences of peri-operative complications and worse survival in the mid-term. Future studies should clarify the pathophysiologic mechanism of this findings and possible therapeutic directions.
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