Timothy S Hall1, Jean C Sines, Alan J Spotnitz. 1. Department of Cardiothoracic Surgery, University of California, PO Box 0118, M593, San Francisco, CA 94143, USA. tshall@itsa.ucsf.edu
Abstract
PURPOSE: Our objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery. METHODS: Retrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures. RESULTS: Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients (P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients (P<0.05). CONCLUSIONS: Pre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.
PURPOSE: Our objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery. METHODS: Retrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures. RESULTS: Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients (P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients (P<0.05). CONCLUSIONS: Pre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.
Authors: Ian J Welsby; Mihai V Podgoreanu; Barbara Phillips-Bute; Richard Morris; Joseph P Mathew; Peter K Smith; Mark F Newman; Debra A Schwinn; Mark Stafford-Smith Journal: J Cardiothorac Vasc Anesth Date: 2010-01-06 Impact factor: 2.628
Authors: Brian A Bruckner; Lance N Blau; Limael Rodriguez; Erik E Suarez; Uy Q Ngo; Michael J Reardon; Matthias Loebe Journal: J Cardiothorac Surg Date: 2014-08-02 Impact factor: 1.637