Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 9;19(1):70.
doi: 10.1186/s12959-021-00324-4.

Use of laboratory testing for prediction of postoperative bleeding volume in cardiovascular surgery

Yoshie Kawahara  1   2 , Kohei Ohtsuka  1 , Kimine Tanaka  1 , Mayumi Yamanaka  1 , Hiroyuki Kamiya  3 , Takayuki Kunisawa  4 , Satoshi Fujii  5
Affiliations

Use of laboratory testing for prediction of postoperative bleeding volume in cardiovascular surgery

Yoshie Kawahara et al. Thromb J. .

Abstract

Background: Coagulopathy and following massive bleeding are complications of cardiovascular surgery, particularly occurring after procedures requiring prolonged cardiopulmonary bypass (CPB). Reliable and rapid tests for coagulopathy are desirable for guiding transfusion. Measuring multiple coagulation parameters may prove useful. The purpose of this study is to determine the laboratory parameters predicting massive bleeding.

Methods: In a prospectively collected cohort of 48 patients undergoing cardiovascular surgery, markers of coagulation and fibrinolysis were measured using automated analyzer and their correlations with bleeding volume were determined.

Results: Operation time was 318 (107-654) min. CPB time was 181 (58-501) min. Bleeding volume during surgery was 2269 (174-10,607) ml. Number of transfusion units during surgery were packed red blood cells 12 (0-30) units, fresh frozen plasma 12 (0-44) units, platelets 20 (0-60) units and intraoperative autologous blood collection 669 (0-4439) ml. Post-surgery activities of coagulation factors II (FII), FV, FVII, FVIII, FIX, FX, FXI and FXII were decreased. Values of fibrinogen, antithrombin, α2 plasmin inhibitor (α2PI) and FXIII were also decreased. Values of thrombin-antithrombin complex (TAT) were increased. Values of FII, FIX, FXI and α2PI before surgery were negatively correlated with bleeding volume (FII, r = - 0.506: FIX, r = - 0.504: FXI, r = - 0.580; α2PI, r = - 0.418). Level of FIX after surgery was negatively correlated with bleeding volume (r = - 0.445) and level of TAT after surgery was positively correlated with bleeding volume (r = 0.443).

Conclusions: These results suggest that several clinical and routine laboratory parameters of coagulation were individually associated with bleeding volume during cardiovascular surgery. Determining the patterns of coagulopathy may potentially help guide transfusion during cardiovascular surgery.

Keywords: Cardiovascular surgery; Diluted coagulopathy; Hemorrhage; Laboratory tests.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no known conflicts of interest associated with this study. During this study CP3000 was provided by Sekisui Medical Company, Tokyo, Japan and STACIA was provided by LSI Medience Corporation, Tokyo, Japan. Sekisui Medical Company and LSI Medience Corporation had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Figures

Fig. 1
Fig. 1
(A) Values of hemoglobin (Hb), platelet (PLT), PT-INR, APTT and fibrinogen (Fib) at point 1 (pre-CPB after induction of anesthesia, or at the time immediately before surgery in patients without CPB) and at point 2 (post-CPB, or at the time right after surgery procedure in patients without CPB). (B) Values of coagulation factor II (FII), FV, FVII, FVIII, FIX, FX, FXI and FXII at point 1 (pre-CPB after induction of anesthesia, or at the time immediately before surgery in patients without CPB) and at point 2 (post-CPB, or at the time right after surgery procedure in patients without CPB). (C) Values of FXIII, antithrombin (AT), α2 plasmin inhibitor (α2PI) and thrombin-antithrombin complex (TAT) at point 1 (pre-CPB after induction of anesthesia, or at the time immediately before surgery in patients without CPB) and at point 2 (post-CPB, or at the time right after surgery procedure in patients without CPB)
Fig. 2
Fig. 2
Correlation of bleeding volume and values of FII, FIX, FXI and α2PI at point 1 (pre-CPB after induction of anesthesia, or at the time immediately before surgery in patients without CPB)
Fig. 3
Fig. 3
Correlation of bleeding volume and values of FIX and TAT at point 2 (post-CPB, or at the time right after surgery procedure in patients without CPB)
See this image and copyright information in PMC

References

    1. Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci. 2010;47:197–212. doi: 10.3109/10408363.2010.549291. - DOI - PubMed
    1. Colson PH, Gaudard P, Fellahi J-L, Bertet H, Faucanie M, Amour J, et al. Active bleeding after cardiac surgery: a prospective observational multicenter study. PLoS One. 2016. 10.1371/journal.pone.0162396. - PMC - PubMed
    1. Bennett-Guerrero E, Zhao Y, O’Brien SM, Ferguson TB, Jr, Peterson ED, Gammie JS, Song HK. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA. 2010;304:1568–1575. doi: 10.1001/jama.2010.1406. - DOI - PubMed
    1. The Society of Thoracic Surgeons Blood Conservation Guideline Task Force, The Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, The International Consortium for Evidence Based Perfusion 2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines. Ann Thorac Surg. 2011;91:944–982. doi: 10.1016/j.athoracsur.2010.11.078. - DOI - PubMed
    1. Goudie R, Sterne JAC, Verheyden V, Bhabra M, Ranucci M, Murphy GJ. Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery. Br J Anaesth. 2015;114:757–766. doi: 10.1093/bja/aeu483. - DOI - PubMed