Excessive Bleeding and Transfusion in a Prior Cardiac Surgery is Associated with Excessive Bleeding and Transfusion in the Next Surgery

Nuttall, Gregory A.; Henderson, Nicole; Quinn, Michael J.; Blair, Clay; Summers, Layne; Williams, Brent A.; Oliver, William C.; Santrach, Paula J.

doi:10.1213/01.ane.0000198563.28246.00

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…Lower preoperative levels of PAI-1 and lower t-PA/PAI-1 complex ratio 24 hours after surgery might have led to higher levels of D-dimer immediately after the surgery [28,29]. Kuepper and co-workers [5] examined 120 patients scheduled for cardiac surgery who were randomized to an aprotinin group and a control group.…”

Section: Discussionmentioning

confidence: 99%

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

et al. 2012

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BackgroundEnhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor – 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding.MethodsTotally 88 adult patients (mean age 66 ± 10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ≤ 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS.ResultsNine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = − 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P < 0.001 and P = 0.012, respectively). Group I displayed significantly lower plasma concentrations of fibrinogen and higher levels of D-dimer from immediately after the operation and throughout the first 24 hours postoperatively.ConclusionsLower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

et al. 2012

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“…Besides, lower preoperative levels of PAI-1 and lower ratio PAI-1/t-PA just after surgery might lead to higher levels of D-dimer later on: this indicates that there are patients with a lower inhibitory potential for fibrinolysis prior and immediately after surgery, possibly favoring EB. These patients may benefit from the use of antifibrinolytic prophylaxis [11,12]. …”

Section: Discussionmentioning

confidence: 99%

Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study

Rivera

Iribarren

Raya

et al. 2007

J Cardiothorac Surg

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“…It is difficult to define the advantages of blood transfusion, but enhanced oxygen-carrying capacity, improved hemostasis and cardiac function volume support are three important aspects [4,5]. However transfusion of blood packs has been more and more recognized as a risk factor for adverse outcome after heart surgery and unnecessary transfusions have been associated with increased morbidity and additional indirect hospitalization costs [6].…”

Section: Introductionmentioning

confidence: 99%

A simple clinical model for planning transfusion quantities in heart surgery

Simeone

Franchi

Cevenini

et al. 2011

BMC Med Inform Decis Mak

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BackgroundPatients undergoing heart surgery continue to be the largest demand on blood transfusions. The need for transfusion is based on the risk of complications due to poor cell oxygenation, however large transfusions are associated with increased morbidity and risk of mortality in heart surgery patients. The aim of this study was to identify preoperative and intraoperative risk factors for transfusion and create a reliable model for planning transfusion quantities in heart surgery procedures.MethodsWe performed an observational study on 3315 consecutive patients who underwent cardiac surgery between January 2000 and December 2007. To estimate the number of packs of red blood cells (PRBC) transfused during heart surgery, we developed a multivariate regression model with discrete coefficients by selecting dummy variables as regressors in a stepwise manner. Model performance was assessed statistically by splitting cases into training and testing sets of the same size, and clinically by investigating the clinical course details of about one quarter of the patients in whom the difference between model estimates and actual number of PRBC transfused was higher than the root mean squared error.ResultsTen preoperative and intraoperative dichotomous variables were entered in the model. Approximating the regression coefficients to the nearest half unit, each dummy regressor equal to one gave a number of half PRBC. The model assigned 4 units for kidney failure requiring preoperative dialysis, 2.5 units for cardiogenic shock, 2 units for minimum hematocrit at cardiopulmonary bypass less than or equal to 20%, 1.5 units for emergency operation, 1 unit for preoperative hematocrit less than or equal to 40%, cardiopulmonary bypass time greater than 130 minutes and type of surgery different from isolated artery bypass grafting, and 0.5 units for urgent operation, age over 70 years and systemic arterial hypertension.ConclusionsThe regression model proved reliable for quantitative planning of number of PRBC in patients undergoing heart surgery. Besides enabling more rational resource allocation of costly blood-conservation strategies and blood bank resources, the results indicated a strong association between some essential postoperative variables and differences between the model estimate and the actual number of packs transfused.

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Excessive Bleeding and Transfusion in a Prior Cardiac Surgery is Associated with Excessive Bleeding and Transfusion in the Next Surgery

Cited by 7 publications

References 20 publications

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study

A simple clinical model for planning transfusion quantities in heart surgery

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