Hypercoagulant Abdominal Swabs in Cardiac Surgery: Potential Problems and Background

Area of Science:

• Cardiovascular Surgery
• Hemostasis and Thrombosis
• Biomaterials Science

Background:

• Abdominal swabs are routinely used during cardiac surgery with heart-lung-machine support to manage blood in the surgical field.
• These swabs can possess procoagulant activity, which is typically considered benign.
• However, abnormal clot formation on swabs and subsequent retransfusion into the extracorporeal circuit may cause thromboembolic complications.

Purpose of the Study:

• To investigate the origin of unexpected blood clotting observed upon contact with hypercoagulant abdominal swabs.
• To characterize the coagulant properties of abdominal swabs and their potential impact on blood coagulation and anticoagulation.

Main Methods:

• Characterization of the coagulant properties of three abdominal swabs using a clotting test with human whole blood anticoagulated with varying heparin concentrations.
• Incubation of blood with eluates from abdominal swabs and polydiallyamine (PDAA) to assess effects on blood clotting.
• Investigation of the impact of abdominal swabs on blood clotting time and heparin activity.

Main Results:

• All three abdominal swabs and their eluates demonstrated distinct coagulant properties.
• The swab with the highest hypercoagulant effect significantly reduced blood clotting time.
• This hypercoagulant swab also led to a reduction in free heparin concentration; PDAA did not activate the coagulation system.

Conclusions:

• Hypercoagulant abdominal swabs can decrease clotting time and the concentration of free heparin.
• Abdominal swabs utilized in complex cardiac surgery require rigorous testing for coagulant properties prior to clinical application.
• The specific component responsible for the hypercoagulant property of these swabs remains unidentified.