Prediction of excessive bleeding after coronary artery bypass graft surgery: The influence of timing and heparinase on thromboelastography

SummaryPlatelet dysfunction can be a major factor in excessive bleeding following cardiopulmonary bypass (CBP). A rapid, specific and sensitive method to identify platelet dysfunction would be a useful tool for identifying patients at an increased risk of bleeding. The ability of PFA100™, an in vitro bleeding test, to predict increased bleeding risk linked to platelet dysfunction was tested in 146 patients undergoing primary coronary artery bypass graft. Blood samples were taken the day before surgery, and 15 min and 5 h after heparin neutralization. The preoperative closure times (CT), i. e. the time required for platelets in citrated whole blood to occlude an aperture cut into a membrane coated with collagen plus either epinephrine (CTEPI) or adenosine diphosphate (CTADP) were longer in blood-group-O patients than in patients with other groups. The 15 min postoperative values were significantly longer from preoperative values essentially owing to CBP-induced hemodilution. Interestingly, 5 h after CBP, a significant reduction in CT values probably reflected platelet hyperaggregability. No correlation was found between calculated blood loss (CBL) and either preoperative or postoperative PFA values.

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Hemorrhage After Coronary Artery Bypass Graft Procedures

Infection Control and Hospital Epidemiology ◽

10.1086/502114 ◽

2003 ◽

Vol 24 (1) ◽

pp. 44-50 ◽

Cited By ~ 24

Author(s):

Loreen A Herwaldt ◽

Sheri K. Swartzendruber ◽

M. Bridget Zimmerman ◽

David A. Scholz ◽

Jo Ann Franklin ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Coronary Artery ◽

Length Of Stay ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Excessive Bleeding

AbstractObjectives:To identify risk factors for excessive bleeding after coronary artery bypass graft (CABG) procedures and to quantify the outcomes related to this complication.Design:We conducted a case–control study to identify risk factors for hemorrhage following CABG surgery and a historical cohort study to quantify outcomes of hemorrhage.Setting:The cardiothoracic surgery service of a university hospital.Results:Factors associated with excessive blood loss were recent catheterization (odds ratio [OR] = 0.44; 95% confidence interval [CI95], 0.21 to 0.91); age older than 65 years (OR = 1.94; CI95, 0.96 to 3.93); bypass time of 150 minutes or more (OR = 2.91; CI95, 1.09 to 7.81); and postoperative platelet count of 160,000/mm3 or less (OR = 2.36; CI95, 1.06 to 5.22). The attributable cost of a postoperative hemorrhage was $3,866 (P= .0002) overall, $9,912 (P= .0001) for patients who required reoperation, and $3,316 (P= .03) for those treated medically. The median attributable postoperative length of stay was 1 day longer for cases than for controls (P= .011). Postoperatively, patients who hemorrhaged received significantly larger volumes of packed red blood cells (P< .0001), fresh frozen plasma (P< .0001), platelets (P< .0001), plasminate (P= .007), protamine sulfate (P< .0001), desmopressin acetate (P< .0001), and epsilon-aminocaproic acid (P< .0001) than did controls.Conclusions:Age, duration of bypass, and postoperative platelet count were associated with excessive bleeding. Hemorrhage after CABG surgery significantly increased the length of stay and cost of care.

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