Chantal L I Gielen1, Anneke Brand2, Waander L van Heerde3, Theo Stijnen4, Robert J M Klautz5, Jeroen Eikenboom6. 1. Dept. of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), The Netherlands. Electronic address: c.l.i.gielen@lumc.nl. 2. Sanquin Blood Bank Leiden, Leiden, The Netherlands. 3. Laboratory of Hematology, Dept. of Laboratory Medicine, Radboudumc, Nijmegen, The Netherlands. 4. Dept. of Medical Statistics, LUMC, Leiden, The Netherlands. 5. Dept. of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), The Netherlands. 6. Dept. of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands.
Abstract
INTRODUCTION: The origination of blood loss after cardiac surgery is not fully explained, but is related to operation trauma and use of cardiopulmonary bypass (CPB). However, the extent of their contribution is incompletely known and might differ between distinct operation procedures. MATERIALS AND METHODS: Three groups of CABG procedures were studied: 1) off-pump coronary artery bypass surgery (OPCAB, n=11) without CPB, 2) CABG with use of CPB (CABG, n=11) and 3) CABG with use of CPB combined with aortic valve replacement (AVR, n=11). Activation of coagulation and fibrinolysis was measured at various time points by flow cytometry, platelet aggregometry, thrombelastography, the Nijmegen Hemostasis Assay, prothrombin fragment 1+2 and tissue plasminogen activator. RESULTS AND CONCLUSIONS: The use of CPB during cardiac surgery decreased platelet counts, clot strength, fibrinogen, hematocrit and albumin concentrations during the procedure. No perioperative platelet activation was observed and functional (collagen induced) platelet aggregation was transiently impaired, but recovered after surgery in all groups. Patients operated with use of CPB showed increased tissue plasminogen activator concentrations after reperfusion followed by minor and transient fibrinolysis. After all types of surgery coagulation parameters and platelet aggregation showed a rebound above preoperative levels. To conclude, no evident platelet activation, dysfunction or consumption was demonstrated. In patients using tranexamic acid the most prominent factor impairing hemostasis after CABG surgery was hemodilution associated with CPB.
INTRODUCTION: The origination of blood loss after cardiac surgery is not fully explained, but is related to operation trauma and use of cardiopulmonary bypass (CPB). However, the extent of their contribution is incompletely known and might differ between distinct operation procedures. MATERIALS AND METHODS: Three groups of CABG procedures were studied: 1) off-pump coronary artery bypass surgery (OPCAB, n=11) without CPB, 2) CABG with use of CPB (CABG, n=11) and 3) CABG with use of CPB combined with aortic valve replacement (AVR, n=11). Activation of coagulation and fibrinolysis was measured at various time points by flow cytometry, platelet aggregometry, thrombelastography, the Nijmegen Hemostasis Assay, prothrombin fragment 1+2 and tissue plasminogen activator. RESULTS AND CONCLUSIONS: The use of CPB during cardiac surgery decreased platelet counts, clot strength, fibrinogen, hematocrit and albumin concentrations during the procedure. No perioperative platelet activation was observed and functional (collagen induced) platelet aggregation was transiently impaired, but recovered after surgery in all groups. Patients operated with use of CPB showed increased tissue plasminogen activator concentrations after reperfusion followed by minor and transient fibrinolysis. After all types of surgery coagulation parameters and platelet aggregation showed a rebound above preoperative levels. To conclude, no evident platelet activation, dysfunction or consumption was demonstrated. In patients using tranexamic acid the most prominent factor impairing hemostasis after CABG surgery was hemodilution associated with CPB.
Authors: Mario Gaudino; Gianni D Angelini; Charalambos Antoniades; Faisal Bakaeen; Umberto Benedetto; Antonio M Calafiore; Antonino Di Franco; Michele Di Mauro; Stephen E Fremes; Leonard N Girardi; David Glineur; Juan Grau; Guo-Wei He; Carlo Patrono; John D Puskas; Marc Ruel; Thomas A Schwann; Derrick Y Tam; James Tatoulis; Robert Tranbaugh; Michael Vallely; Marco A Zenati; Michael Mack; David P Taggart Journal: J Am Heart Assoc Date: 2018-08-21 Impact factor: 5.501