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[Hemostatic changes after artificial valve replacement--especially tricuspid regurgitation]
1Department of Cardiovascular Surgery, Fukushima Medical College, Japan.
To investigate hemostatic changes after artificial valve replacement, I studied platelets, fibrinogen (Fbg), antithrombin III (AT-III), fibrinogen degradation products (FDP), thrombotest (TT), prothrombin time (PT), bleeding time (BT) and activated partial thromboplastin time (APTT) in 75 patients complicated with combined cardiac valvular disease. Twenty-nine patients with tricuspid regurgitation (TR group) and 46 patients without that (control group) were compared. 1) TR group, that contained patients with severer cases, showed a significantly longer operative time and greater bleeding volume than control group (p less than 0.01). 2) Many patients in TR group showed high serum II, frequency of abnormal platelet functions during and after extracorporeal circulation total-bilirubin and GPT level after operation and higher ICG R-value before operation than in control group. 3) After operation, the platelet count was significantly lower in TR group (p less than 0.01) than in control group, and was lowest on the 3rd postoperative day in both groups. 4) In both groups Fbg increased significantly after operation, and was lower in TR group on the 7th and 10th postoperative days than in control group. FDP was significantly higher in TR group than in control group after the 3rd postoperative day. 5) BT and APTT were similar in the two groups. 6) PT and TT were lower in TR group before operation (p less than 0.01) than in control group, and decreased after operation and administration of anticoagulants in both groups. These results indicate that patients with combined cardiac valvular disease with tricuspid regurgitation have a hemorrhagic tendency due to disorders of extrinsic coagulant, which may be caused by liver hypofunction, and are easy to bleed.
To investigate hemostatic changes after artificial valve replacement, I studied platelets, fibrinogen (Fbg), antithrombin III (AT-III), fibrinogen degradation products (FDP), thrombotest (TT), prothrombin time (PT), bleeding time (BT) and activated partial thromboplastin time (APTT) in 75 patients complicated with combined cardiac valvular disease. Twenty-nine patients with tricuspid regurgitation (TR group) and 46 patients without that (control group) were compared. 1) TR group, that contained patients with severer cases, showed a significantly longer operative time and greater bleeding volume than control group (p less than 0.01). 2) Many patients in TR group showed high serum II, frequency of abnormal platelet functions during and after extracorporeal circulation total-bilirubin and GPT level after operation and higher ICG R-value before operation than in control group. 3) After operation, the platelet count was significantly lower in TR group (p less than 0.01) than in control group, and was lowest on the 3rd postoperative day in both groups. 4) In both groups Fbg increased significantly after operation, and was lower in TR group on the 7th and 10th postoperative days than in control group. FDP was significantly higher in TR group than in control group after the 3rd postoperative day. 5) BT and APTT were similar in the two groups. 6) PT and TT were lower in TR group before operation (p less than 0.01) than in control group, and decreased after operation and administration of anticoagulants in both groups. These results indicate that patients with combined cardiac valvular disease with tricuspid regurgitation have a hemorrhagic tendency due to disorders of extrinsic coagulant, which may be caused by liver hypofunction, and are easy to bleed.