Hemostatic abnormalities associated with prolonged ventricular assist pumping: analysis of 24 patients

Bleeding remains a serious problem in patients with ventricular assist pumping (VAP). Clinical and hemostatic laboratory data in 24 patients who could not be separated from cardiopulmonary bypass (CPB) at the conclusion of open heart surgery and who underwent VAP for 54 to 610 hours were analyzed. The most important variable that correlated with the occurrence of severe bleeding was the duration of CPB: 5.2 +/- 1.6 hours in 13 patients with excessive bleeding, vs 3.6 +/- 1.1 hours in 11 patients with "acceptable" levels of bleeding (p less than 0.01). Moderate thrombocytopenia occurred in all patients but did not appear to be a major contributing factor to excessive bleeding. Disseminated intravascular coagulation (DIC) occurred in 12 patients, 4 of whom were in cardiogenic shock. DIC also correlated with time on CPB: 5.2 +/- 1.7 hours for patients with DIC, vs 3.7 +/- 1.1 hours for patients without DIC (p less than 0.01). No correlation was noted between the duration of VAP and the occurrence of DIC or bleeding.