Hemostatic alterations during coronary artery bypass grafting

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Chantal L I Gielen1, Anneke Brand2, Waander L van Heerde3

  • 1Dept. of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), The Netherlands.

Thrombosis Research
|January 23, 2016
PubMed

Insights

Cardiopulmonary bypass (CPB) in cardiac surgery reduces blood clotting factors and platelet function, but hemodilution is the main cause of bleeding post-CABG, not platelet activation.

Area of Science:

  • Cardiovascular Surgery
  • Hemostasis and Thrombosis

Background:

  • Blood loss after cardiac surgery is multifactorial, involving surgical trauma and cardiopulmonary bypass (CPB).
  • The specific contributions of CPB and surgical techniques to bleeding remain unclear.

Purpose of the Study:

  • To investigate the impact of different cardiac surgery procedures on coagulation and fibrinolysis.
  • To determine the primary causes of impaired hemostasis after coronary artery bypass grafting (CABG).

Main Methods:

  • Compared three CABG groups: off-pump (OPCAB), CABG with CPB, and CABG with CPB plus aortic valve replacement (AVR).
  • Assessed coagulation and fibrinolysis using flow cytometry, platelet aggregometry, thrombelastography, Nijmegen Hemostasis Assay, prothrombin fragment 1+2, and tissue plasminogen activator.

Main Results:

  • CPB use decreased platelet counts, clot strength, fibrinogen, hematocrit, and albumin.
  • Platelet aggregation was transiently impaired but recovered post-surgery; no perioperative platelet activation was observed.
  • Increased tissue plasminogen activator and minor fibrinolysis occurred after reperfusion in CPB groups.

Conclusions:

  • No significant platelet activation, dysfunction, or consumption was evident after cardiac surgery.
  • Hemodilution associated with CPB was identified as the primary factor impairing hemostasis in patients receiving tranexamic acid.
  • Coagulation parameters and platelet aggregation rebounded above baseline levels post-surgery.
Abstract

Keywords:
Bleeding, bleeding controlBlood coagulationCardiopulmonary bypassSurgery, complications

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