Cagla Demirci1, Florian Zeman2, Christof Schmid3, Bernhard Floerchinger4. 1. Department of Internal Medicine I, University Medical Center Regensburg, Germany. 2. Center of Clinical Studies, University Medical Center Regensburg, Germany. 3. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Germany. 4. Department of Cardiothoracic Surgery, University Medical Center Regensburg, Germany. Electronic address: bernhard.floerchinger@ukr.de.
Abstract
BACKGROUND: Increased blood loss after cardiac surgery is a risk factor for patient morbidity and mortality. Guidelines for postoperative haemodynamics management recommend normotensive blood pressure to avoid increased chest drain volumes. The aim of this study was to verify the correlation of early postoperative hypertension and blood loss in patients after cardiac surgery during the early postoperative period. METHODS: Postoperative mean blood pressure values and chest drain volumes of 431 patients were registered by an intensive care monitoring system during first 60minutes after intensive care admission. Correlation between blood pressure and blood loss was calculated by linear regression analysis. RESULTS: In the entire patient cohort and in various subgroup analyses (body-mass-index, type of surgery, comorbidity, emergency surgery, preoperative anticoagulation therapy) no association between early mean blood pressure >80mmHg and increased blood loss was evident in simple regression analysis. Merely, after aortic surgery a correlation of hypertension and blood loss was found. Multiple regression revealed postoperative INR values >1.5 and thrombocyte counts <100.000/nL to impact blood loss in contrast to postoperative hypertension. CONCLUSION: Evidence for strict blood pressure management to reduce blood loss after cardiac surgery is scarce. Instead, in face of higher INR and low thrombocytes increasing postoperative blood loss, achieving and maintaining a physiological coagulation is essential.
BACKGROUND: Increased blood loss after cardiac surgery is a risk factor for patient morbidity and mortality. Guidelines for postoperative haemodynamics management recommend normotensive blood pressure to avoid increased chest drain volumes. The aim of this study was to verify the correlation of early postoperative hypertension and blood loss in patients after cardiac surgery during the early postoperative period. METHODS: Postoperative mean blood pressure values and chest drain volumes of 431 patients were registered by an intensive care monitoring system during first 60minutes after intensive care admission. Correlation between blood pressure and blood loss was calculated by linear regression analysis. RESULTS: In the entire patient cohort and in various subgroup analyses (body-mass-index, type of surgery, comorbidity, emergency surgery, preoperative anticoagulation therapy) no association between early mean blood pressure >80mmHg and increased blood loss was evident in simple regression analysis. Merely, after aortic surgery a correlation of hypertension and blood loss was found. Multiple regression revealed postoperative INR values >1.5 and thrombocyte counts <100.000/nL to impact blood loss in contrast to postoperative hypertension. CONCLUSION: Evidence for strict blood pressure management to reduce blood loss after cardiac surgery is scarce. Instead, in face of higher INR and low thrombocytes increasing postoperative blood loss, achieving and maintaining a physiological coagulation is essential.