Hemostatic alterations during coronary artery bypass grafting

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. Materi...

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Bibliographic Details
Published in:Thrombosis research 2016-04, Vol.140, p.140-146
Main Authors: Gielen, Chantal L.I, Brand, Anneke, van Heerde, Waander L, Stijnen, Theo, Klautz, Robert J.M, Eikenboom, Jeroen
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Bleeding, bleeding control
Blood Coagulation
Blood Coagulation Tests
Cardiopulmonary bypass
Coronary Artery Bypass - methods
Coronary Artery Bypass, Off-Pump - methods
Female
Hematocrit
Hematology, Oncology and Palliative Medicine
Hemostasis
Humans
Male
Middle Aged
Platelet Aggregation
Platelet Count
Surgery, complications
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Summary: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.
ISSN:0049-3848
1879-2472
DOI:10.1016/j.thromres.2015.12.018