Management of Bleeding and Coagulopathy After Heart Surgery

Milas, Bonnie L.; Jobes, David R.; Gorman, Robert G.

doi:10.1053/stcs.2000.20511

Cited by 32 publications

(23 citation statements)

References 25 publications

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“…It has been proved that CPB causes a reduction in the levels of coagulation factors, stimulates fibrinolysis, induces thrombocytopenia [14], disseminating intravascular coagulation and platelet dysfunction [15,16]. Also the effects of circulating heparin and protamine must be considered [17]. Our findings confirm this hypothesis, as the use of CPB, its temperature and, specifically, its prolonged use were directly associated to greater bleeding within the first 24 postoperative hours.…”

Section: Commentssupporting

confidence: 81%

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To determine predictors of postoperative bleeding after cardiac surgery, in order to focus on preventive measures for high-risk populations.Methods: From October 2001 to March 2002, 411 consecutive adult cardiac surgery patients were prospectively studied, with the exception of those submitted to heart transplantation. In order to determine risk factors for postoperative bleeding, 20 preoperative, 17 operative and 6 postoperative variables were analyzed using univariate methods and multiple linear regression.Results: Operative procedures included coronary artery bypass grafting in 227 (55.2%) patients, valvar operations in 198 (48.2%), aortic surgery in 25 (6.1%) and combined procedures in 60 (14.6%). Cardiopulmonary bypass was used in 335 (81.5%) patients and anti-fibrinolysis agents in 148 (36%). The thirty-day mortality rate was 5.6% (23 patients). Mean 24-hour postoperative blood loss was 610 ± 500 mL (range 10-4900). Re-exploration for bleeding was required in 15 (3.7%) patients. Independent predictors of postoperative bleeding were emergency operations (p=0.049), postoperative metabolic acidosis (p=0.001), preoperative thrombocytopenia (p=0.034) and prolonged cardiopulmonary bypass (p=0.021).Conclusions: When possible, preoperative stabilization and correction of coagulation disturbances should be achieved in patients requiring urgent or emergent surgery and in those with thrombocytopenia. The duration of cardiopulmonary bypass should be minimized as long as this is practical. Postoperative metabolic acidosis must be actively corrected, especially the main determining causes. Descriptors

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Section: Commentssupporting

confidence: 81%

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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“…Such a classification of patients was deemed necessary to minimize postprocedural bleeding and was supported by studies that have identified high-bleeding-risk procedures. [36][37][38][39][40][41][42][43] There are no clinical prediction rules, to our knowledge, that stratify patients according to the risk of postprocedural bleeding. 57 Third, because this patient registry did not include a control group, we cannot comment on the efficacy or safety of our periprocedural anticoagulation regimen compared with other strategies that might involve intravenous heparin, 11,12 or warfarin interruption without bridging anticoagulation.…”

Section: Commentmentioning

confidence: 99%

Low-Molecular-Weight Heparin as Bridging Anticoagulation During Interruption of Warfarin

Douketis¹,

Johnson²,

Turpie³

2004

Arch Intern Med

310

213

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“…A lthough cardiac surgery patients are at risk for hemorrhagic complications such as blood loss and transfusion (1,2), they are, paradoxically, also at risk for thrombotic complications, including coronary and cerebral ischemia (3)(4)(5)(6)(7). After cardiopulmonary bypass (CPB), a prothrombotic state exists because of activation of the coagulation, complement, and inflammatory pathways (8 -12).…”

mentioning

confidence: 99%

The Response to Activated Protein C After Cardiopulmonary Bypass: Impact of Factor V Leiden

Donahue

2004

Anesthesia & Analgesia

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Activated protein C (aPC) resistance is a recognized hypercoagulable phenotype that is associated with increased risk for thrombosis in multiple clinical settings. Factor V Leiden (FVL) represents a specific inherited cause of aPC resistance, but the perioperative thrombotic risk of FVL is unclear. In this investigation, we sought to quantify whether cardiopulmonary bypass produces alterations in aPC resistance in FVL carriers and noncarrier controls, testing the hypothesis that FVL is associated with a relatively hypercoagulable postoperative state. Two-hundred-five adult cardiac surgery patients were prospectively enrolled into a genetic registry whose purpose was to study the impact of genetic variables on clinical outcomes. For this study, 8 subjects heterozygous for FVL were identified (group L), as well as 2 control groups: group MC, matched controls, 18 matched subjects without FVL; and group UC, unmatched controls, 11 consecutive subjects without FVL. Plasma was sampled at the beginning of surgery, 10 min after protamine administration, and on postoperative day 1, and assayed for resistance to aPC (normal aPC ratio is >2.0). Both MC and UC groups exhibited normal aPC ratio at baseline (2.40 and 2.36, respectively), which increased significantly (to 2.76 and 2.75, P = 0.007 and 0.021, respectively) on postoperative day 1, indicating increased postoperative sensitivity to aPC. Conversely, group L subjects exhibited aPC resistance at baseline (aPC ratio 1.80), and did not change significantly postoperatively (P = 0.867). Patients without FVL therefore show laboratory evidence consistent with relative protection from postoperative thrombosis, whereas FVL carriers do not. These findings provide mechanistic support for previous speculations of increased postoperative thrombotic risk associated with FVL.

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Management of Bleeding and Coagulopathy After Heart Surgery

Cited by 32 publications

References 25 publications

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Low-Molecular-Weight Heparin as Bridging Anticoagulation During Interruption of Warfarin

The Response to Activated Protein C After Cardiopulmonary Bypass: Impact of Factor V Leiden

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