Predictive value of blood clotting tests in cardiac surgical patients

Gravlee, G.P.; Arora, Sunil; Lavender, Sidney W.; Mills, Stephen A.; Hudspeth, Allen S.; Cordell, A. Robert; James, Robert L.; Brockschmidt, Joni K.; Stuart, John J.

doi:10.1016/0003-4975(94)91103-7

Cited by 93 publications

(45 citation statements)

References 25 publications

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“…Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are poor predictors of bleeding during invasive procedures [10][11][12] and are usually not available quickly enough to be clinically useful in a patient who is bleeding. Measuring the viscoelastic properties of coagulating whole blood by TEG Ò or Rotem Ò are useful in the management of a patient who is bleeding [1,13,14] but it is not clear whether these tests predict post-operative bleeding.…”

Section: Introductionmentioning

confidence: 99%

Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with postoperative bleeding

Coakley

Hall

Evans

et al. 2011

Journal of Thrombosis and Haemostasis

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Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with post-operative bleeding.J Thromb Haemost 2011; 9: 282-92.Summary. Background: Bleeding after cardiopulmonary bypass (CPB) is a major cause of morbidity and mortality and consumes large amounts of blood. Identifying patients at increased risk of bleeding secondary to hemostatic impairment may improve clinical outcomes by allowing early intervention. Methods: This present study recruited 77 patients undergoing CPB and measured coagulation screens, coagulation factors, TEG Ò , Rotem Ò and thrombin generation (TG) before surgery and 30 min after heparin reversal. The tests were analyzed to investigate whether they identified patients at increased risk of excess bleeding (defined as > 1000 mL) in the first 24 h postoperatively. Results: Patients who bled > 1000 mL had a lower: platelet count (P < 0.02), factors (F)IX, X and XI (P < 0.005), endogenous thrombin potential (ETP) and an initial rate of TG (P < 0.02) and higher activated partial thromboplastin time (aPTT) (P < 0.001) than patients who bled < 1000 mL. Receiver operating characteristic (ROC) analysis was significant for post-operative TG and aPTT (P < 0.001). Furthermore, reduced pre-operative TG was associated with increased postoperative bleeding (P < 0.02). Pre-and postoperative TG were correlated (q = 0.7, P < 0.001). TEG Ò , Rotem Ò and prothrombin time (PT) at either time point were not associated with increased bleeding. Conclusion: These data suggest that pre-operative defects in the propagation phase of hemostasis are exacerbated during CPB, contributing to bleeding post-CPB. TG taken both pre-and postoperatively could potentially be used to identify patients at an increased risk of bleeding post-CPB.

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Section: Introductionmentioning

confidence: 99%

Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with postoperative bleeding

Coakley

Hall

Evans

et al. 2011

Journal of Thrombosis and Haemostasis

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“…Endpoint assays are traditionally performed on blood plasma and include such tests as the pro-thrombin time (PT), activated partial thromboplastin time (aPTT), and the activated clotting time (ACT). While each of these assays measures a different aspect of the coagulation cascade, even in combination they do not provide a complete representation of overall hemostasis [15, 16]. These tests are further limited by the absence of active platelets.…”

Section: Introductionmentioning

confidence: 99%

A novel ultrasound-based method to evaluate hemostatic function of whole blood

Viola

Mauldin

Lin-Schmidt

et al. 2010

Clinica Chimica Acta

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Background: Unregulated hemostasis represents a leading cause of mortality and morbidity in the developed world. Being able to recognize and quantify defects of the hemostatic process is critical to reduce mortality and implement appropriate treatment. Methods:We describe a novel ultrasound-based technology, named sonorheometry, which can assess hemostasis function from a small sample of blood. Sonorheometry uses the phenomenon of acoustic radiation force to measure the dynamic changes in blood viscoelasticity during clot formation and clot dissolution. We performed in vitro experiments using whole blood samples of 1ml to demonstrate that sonorheometry is indicative of hemostatic functions that depend on plasma coagulation factors, platelets, and plasma fibrinolytic factors.Results: Sonorheometry measurements show titration effects to compounds known to alter the coagulation factors (GPRP peptide, 0 to 8 mmol/l), platelets (abciximab, 0 to 12 ug/ml), and fibrinolytic factors (urokinase, 0 to 200U). Repeated measurements of blood samples from the same subjects yielded reproducibility errors on the order of 5%. Conclusions:These data indicate that sonorheometry accurately quantifies the functional role of the components of hemostasis in vitro.

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“…The results of routine clotting tests are frequently abnormal after cardiac surgery and are associated with reduced concentrations of coagulation factors, but it is not clear whether these abnormal clotting tests are clinically useful (Woodman & Harker, 1990;Kozek-Langenecker et al, 2011). Some studies have shown a clear relationship between abnormalities in prothrombin time (PT) and activated partial thromboplastin time (aPTT) and excessive bleeding after cardiac surgery (Marengo-Rowe et al, 1979;Nuttall et al, 1997), but others have not been able to discriminate between patients that bleed and patients that do not bleed perioperatively using such coagulation tests (Woodman & Harker, 1990;Gravlee et al, 1994;Kozek-Langenecker et al, 2011). Post-operatively, the use of blood and blood products to reduce bleeding is sometimes empirically based rather than based on interpretation of laboratory or point of care test data.…”

Section: Cpb and Haemostasismentioning

confidence: 99%

State of the Art – How I manage coagulopathy in cardiac surgery patients

Davidson

2014

Br J Haematol

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SummaryOver 35 000 cardiac operations using cardiopulmonary bypass are performed annually in the UK. Post-operative bleeding is a common cause of morbidity. Although there have been improvements in surgical techniques, recent publications still show post-operative blood loss to be significant, with allogeneic blood product usage as high as 50%. Despite greater understanding of the mechanisms of the coagulopathy encountered during cardiac surgery the development of treatment options has been slow. There has been a realization of the inadequacy of fresh frozen plasma to correct the coagulopathy in this setting, leading to greater off-label use of specific factor concentrates to stop bleeding, e.g., prothrombin complex concentrates and fibrinogen concentrates. Recent trials using factor XIII and IX concentrates have not been successful. This article will review preventative measures to reduce post-operative bleeding and the current management of bleeding with such factor concentrates and, in most cases, the limited evidence supporting their widespread use.

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Predictive value of blood clotting tests in cardiac surgical patients

Cited by 93 publications

References 25 publications

Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with postoperative bleeding

Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with postoperative bleeding

A novel ultrasound-based method to evaluate hemostatic function of whole blood

State of the Art – How I manage coagulopathy in cardiac surgery patients

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