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Hemostasis changes during cardiopulmonary bypass surgery.

E F Mammen, M H Koets, B C Washington

    Seminars in Thrombosis and Hemostasis
    |July 1, 1985
    PubMed
    Summary
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    Cardiopulmonary bypass (CPB) significantly reduces clotting factors and platelet counts during open heart surgery. While most factors recover post-surgery, platelet function remains impaired, impacting hemostasis.

    Area of Science:

    • Cardiovascular Surgery
    • Hematology
    • Anesthesiology

    Background:

    • Open heart surgery frequently requires cardiopulmonary bypass (CPB).
    • CPB can significantly alter hemostasis parameters.
    • Understanding these alterations is crucial for patient management.

    Purpose of the Study:

    • To investigate changes in various hemostasis parameters during and after CPB.
    • To assess the impact of CPB on clotting factors and platelet function.
    • To correlate laboratory findings with clinical hemostasis.

    Main Methods:

    • Assayed fibrinogen, clotting factors (II, V, VIII:C, X, XI), antithrombin, plasminogen, alpha 2-antiplasmin, and platelet counts in 63 patients.
    • Studied platelet function (counts, mean volume, aggregation) in 30 additional patients.

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  • Measurements taken at multiple time points: pre-surgery, during CPB, post-CPB, and postoperatively.

    • Main Results:

    • All assayed clotting factors decreased significantly during CPB, generally paralleling hematocrit.
    • Platelet counts and aggregation decreased during CPB and remained low postoperatively.
    • Clotting factor levels recovered significantly by 48 hours post-surgery, rarely dropping to clinically compromised levels.

    Conclusions:

    • CPB induces significant, though generally reversible, reductions in clotting factors.
    • Platelet function is markedly impaired during and after CPB.
    • Despite factor reductions, hemostasis is rarely compromised, but platelet function deficits warrant attention.