Factor V Leiden Protects Against Blood Loss and Transfusion After Cardiac Surgery

Abstract

Background-The outcome of cardiac surgery is influenced by several factors, but the impact of specific genetic variants has not been systematically explored. Because blood conservation is a pressing issue in cardiac surgery, we tested the hypothesis that factor V Leiden (FVL), a common coagulation factor polymorphism, may protect against blood loss and transfusion in patients undergoing cardiac surgery. Methods and Results-We enrolled 517 patients undergoing cardiac surgery, including 26 heterozygous FVL carriers, and evaluated the impact of FVL on chest tube output and transfusion by using univariate and multivariate techniques. For patients with FVL, blood loss at 6 (238Ϯ131 mL) and 24 hours (522Ϯ302 mL) was significantly lower than that for noncarriers (358Ϯ259 mL and 730Ϯ452 mL; PϽ0.001 and Pϭ0.001, respectively). In a multivariate regression analysis, controlling for ethnicity and factors known to affect blood loss, FVL was a significant independent contributor at both time points. Using a similar regression approach, FVL did not have a significant effect on the number of units transfused. However, logistic regression of the risk of receiving any transfusion during hospitalization demonstrated a significant independent protective effect of FVL on overall transfusion risk. Conclusions-FVL represents a common genetic trait that may protect against blood loss and transfusion in this population. This study demonstrates that genetic variability can affect the outcome of cardiac surgery. (Circulation.

The effect of aprotinin on activated protein C‐mediated downregulation of endogenous thrombin generation

“…Another controversial issue is the use of aprotinin in patients with factor V Leiden genotypes. Although the carriers of factor V Leiden mutation that undergo CPB have been reported to have a lower transfusion rate and chest tube drainage compared with non-carrier patients (Sweeney et al, 1997;Donahue et al, 2003), the association between arterial thromboses (e.g. graft occlusion) and factor V mutation is not conclusive (Nicolaes & Dahlback, 2003).…”

The Factor V Leiden mutation is associated with a higher blood haemoglobin concentration in women below 50 of the Malmö Thrombophilia Study (MATS)

“…Brian S et al 2003 [12] have shown decreased blood loss during cardiac surgery in patients carrying the FVLmutation, and recently published studies, on both mice and men, show beneficial effects of the FVL-mutation on the outcome of severe inflammatory diseases and sepsis [15][16][17]. polymorphisms, exerting both positive and negative evolutionary pressure.…”

“…Women with FVL-mutation were also characterized by higher postpartum haemoglobin (Hb) values, less risk of postpartum anaemia [9], higher Hb-values and ferretin values in early pregnancy, and lower self-estimated menstrual blood loss [11]. Furthermore, studies in other patients groups with FVL-mutation undergoing cardiac surgery show significantly lower blood losses at 6 and 24 hours compared to non-carriers [12].…”

Pharmacogenomics and end-organ susceptibility to injury in the perioperative period

“…Genetic variants have been found for adverse events such as myocardial ischemia [53], postoperative arrhythmias [54], vein graft restenosis [55], transplant rejection [56], renal compromise [57,58], neurocognitive dysfunction [59,60], stroke [61], and death [62], as well as more systemic outcomes such as bleeding [63], thrombosis [64], inflammatory responses and severe sepsis [65], and alterations in vascular reactivity [66] (see Podgoreanu [2]). Even more broadly, genetic variants affecting inflammatory responses have been identified.…”