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Correlations between global clotting function tests, duration of operation, and postoperative chest tube drainage in
Tamaki Hayashi1, Yoshihiko Sakurai, Kazuyoshi Fukuda
1Department of Pediatrics, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Insights
Preoperative clot formation time (CFT) and endogenous thrombin potential (ETP) can predict postoperative bleeding after cardiac surgery. These global coagulation assays offer valuable insights for managing bleeding risk in pediatric patients.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Pediatric Medicine
Background:
- Systemic coagulation disorders are significant complications following cardiac surgery.
- Predicting postoperative bleeding using preoperative coagulation tests remains challenging.
- Identifying reliable predictive markers for hemorrhage is crucial.
Purpose of the Study:
- To investigate the relationship between postoperative hemorrhage and global coagulation assay parameters.
- To identify potential preoperative markers for predicting bleeding after cardiac surgery.
Main Methods:
- Enrolled 21 pediatric patients undergoing cardiac surgery.
- Collected blood samples preoperatively and 24 hours postoperatively.
- Utilized rotation thromboelastometry (ROTEM) and thrombin generation test (TGT) alongside classical coagulation tests.
Main Results:
- Preoperative clot formation time (CFT) and endogenous thrombin potential (ETP) correlated with postoperative chest tube drainage.
- Classical coagulation tests were not informative for predicting bleeding.
- Postoperative parameters including ROTEM and TGT results, and duration of surgery, also correlated with bleeding volume.
Conclusions:
- Preoperative CFT and ETP are valuable predictors of postoperative chest tube drainage.
- Surgical duration is also a significant factor influencing bleeding and ROTEM parameters.
Background:
Systemic coagulation disorders after cardiac surgery represent serious postoperative complications. There have been few reports, however, identifying preoperative coagulation tests that predict postoperative bleeding. The aim of the present study was to investigate the relationship between postoperative hemorrhage and coagulation parameters determined by global coagulation assays, to define potential predictive markers.
Methods:
Twenty-one pediatric patients were enrolled. Blood samples were collected before and 24 h after cardiac surgery. Laboratory investigations included platelet count, hematocrit, classical coagulation tests [prothrombin time, activated partial thromboplastin time, thrombin-antithrombin complex (TAT)], rotation thromboelastometry (ROTEM), and the thrombin generation test (TGT). The duration of the surgical procedure was recorded. Chest tube drainage was monitored for 24 h after operation as an index of postoperative hemorrhage.
Results:
Comparisons between preoperative and postoperative results indicated that TAT increased significantly after operation, whereas ROTEM parameters did not show a hypercoagulable pattern. Preoperative endogenous thrombin potential (ETP) measured in the TGT and clot formation time (CFT) in the ROTEM correlated with chest tube drainage. The classical coagulation tests were not informative. Postoperatively, peak height and ETP in TGT, all ROTEM parameters, and duration of surgery were correlated with chest tube drainage. Duration of surgery was correlated with postoperative ROTEM parameters but not with TGT. Postoperative maximum clot firmness and AUC were correlated with platelet count decrease ratio.
Conclusions:
The preoperative CFT and ETP provide useful indices for predicting postoperative chest tube drainage volume. In addition, the duration of surgery also correlated with chest tube drainage and affected ROTEM parameters.
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