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The evaluation of hemorrhage in cardiac patients who have undergone extracorporeal circulation
Insights
This study identifies key coagulation tests to predict excessive bleeding after cardiopulmonary bypass surgery. Specific PTT, PT, and fibrinogen levels effectively identify patients at risk, enabling targeted interventions.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Coagulation Science
Background:
- Excessive bleeding is a significant complication following cardiopulmonary bypass.
- Predicting and managing postoperative hemorrhage is crucial for patient outcomes.
Purpose of the Study:
- To define excessive bleeding after cardiopulmonary bypass.
- To evaluate the efficacy of coagulation testing in predicting excessive postoperative bleeding.
Main Methods:
- Analysis of 774 patients undergoing aortocoronary bypass surgery.
- Definition of excessive hemorrhage as >600 ml chest tube drainage in 8 hours postoperatively.
- Assessment of various coagulation parameters including PTT, PT, fibrinogen, and TFT.
Main Results:
- 163 patients (21%) experienced excessive bleeding.
- Elevated PTT (>45s), PT (>19s), low fibrinogen (<225 mg/dl), and low TFT (≤1:32) were significant predictors.
- Platelet function/count and fibrinogen split products showed no prognostic value.
- The defined criteria reduced re-exploration rates to 0.6%.
Conclusions:
- Specific coagulation test results can predict excessive bleeding after cardiopulmonary bypass.
- Preoperative hemostatic tests were not useful for predicting bypass-related coagulopathies.
Abstract:
The present study defines excessive bleeding in patients who undergo cardiopulmonary bypass, and evaluates the use of coagulation testing to predict those patients that bleed excessively. Evaluation of 774 consecutive patients undergoing aortocoronary bypass surgery was carried out. Cardiopulmonary bypass consisted of a bloodless prime and a Harvey bubble oxygenator. In the postoperative period, excessive hemorrhage was defined as that exceeding 600 ml chest tube drainage in the first eight hours. One hundred and sixty-three patients (21%) were noted to be in this category. Excessive bleeding postoperatively was best predicted by a PTT greater than 45 seconds, a PT greater than 19 seconds, a fibrinogen level less than 225 mg/dl and a TFT equal to or less than 1:32. These laboratory findings occur singly or in combination. The assessment of platelet, numbers or function and fibrin(ogen) split products were of no prognostic value. Using these criteria, the re-exploration rate for excessive hemorrhage and/or tamponade was 0.6 per cent (5 out of 774 patients). No preoperative laboratory test of hemostatic function was useful in predicting coagulopathies resulting from cardiopulmonary bypass.