Association of the 98T ELAM-1 polymorphism with increased bleeding after cardiac surgery

Abstract

Objective: Hemorrhage continues to be a major problem after cardiac surgery despite the routine use of antifibrinolytic drugs, with striking inter-patient variability poorly explained by already known risk factors. The authors tested the hypothesis that genetic polymorphisms of inflammatory mediators and cellular adhesion molecules are associated with bleeding after cardiac surgery.

Design: Prospective, observational study.

Setting: Single, tertiary referral university heart center.

Participants: Adult patients undergoing aortocoronary surgery with cardiopulmonary bypass.

Interventions: Patients (n = 759) had 10 mL of blood drawn preoperatively and genomic DNA isolated then genotyped for 17 polymorphisms in 7 candidate genes: tumor necrosis factor, interleukins 1beta and 6, interleukin 1 receptor antagonist, intercellular adhesion molecule-1 (ICAM-1), P-selectin and endothelial leucocyte adhesion molecule-1 (E-selectin). Multivariate analyses were used to relate clinical and genetic factors to bleeding and transfusion.

Measurements and main results: The 98G/T polymorphism of the E-selectin gene was independently associated with bleeding after cardiac surgery (p = 0.002), after adjusting for significant clinical predictors (patient size and baseline hemoglobin concentration). There was a gene dose effect according to the number of minor alleles in the genotype; carriers of the minor allele bled 17% (GT) and 54% (TT) more than wild type (GG) genotypes, respectively (p = 0.01). Carriers of the minor allele also had longer activated partial thromboplastin times (p = 0.0023) and increased fresh frozen plasma transfusion (p = 0.03) compared with wild type.

Conclusions: The authors found a dose-related association between the 98T E-selectin polymorphism and bleeding after cardiac surgery, independent of and additive to standard clinical risk factors.

Figure 1

Bleeding, described as chest tube drainage at 4 and 12 hour postoperative timepoints, expressed graphically as median and interquartile range and tabulated as number and percentage of patients, by genotype, demonstrated excessive drainage defined as the upper quartile of the whole sample (n=668). Patients are categorized as wild type (GG) and carriers of one (GT) and two (TT) minor alleles of the ELAM-1 gene 98GT polymorphism.

Figure 2