Factors associated with excessive bleeding following elective on‐pump coronary artery bypass grafting

Abstract

Introduction Excessive bleeding following cardiac surgery is associated with worse outcomes. We aimed to analyze preoperative and operative factors associated with excessive bleeding in coronary artery bypass patients to better understand which patients are under increased risk. Methods The study was conducted as an observational study in a tertiary center for cardiac surgery by retrospective analysis of the hospital database. Patients were grouped according to chest tube output within the postoperative 24 h. Patients in the 4th percentile of chest tube output per kilogram were categorized as having excessive bleeding. Patients with excessive bleeding were compared with the other patients for preoperative and operative factors. Factors significant in univariate analysis were carried onto the multivariate analysis. Results Patients with excessive bleeding were more likely to be males (91.4% vs. 78.7%, p = .002), have lower body mass index (BMI) (27.4 vs. 29.2, p < .001), and low platelets (6.9% vs. 1.5%, p = .006). Cardiopulmonary bypass (101.8 vs. 110.9 min, p = .022) time was longer in the excessive bleeding group. Patients with excessive bleeding were more likely to have more than three vessels revascularized. Male sex, lower BMI, low platelets, and longer cardiopulmonary bypass time were independently associated with increased bleeding. Conclusion Male sex, lower BMI, low platelet count, and longer cardiopulmonary bypass time are associated with extensive bleeding after elective coronary artery bypass surgery (CABG). Patients with higher bleeding risk should be identified preoperatively to account for adverse outcomes after CABG.

Comparison of Prothrombin Complex Concentrate with Activated Factor VII Use for Bleeding Following Cardiopulmonary Bypass in Children

“…Longer duration of CPB is correlated with increased coagulopathy in both children and adults. 1,[24][25][26] Additionally, lower core body temperature in both children and adults undergoing CPB has been correlated with increased coagulopathy. 1,[26][27][28] In our study, children who received rFVIIa had a significantly longer time on CPB and significantly lower core body temperature on CPB when compared with the PCC group.…”

On factors that influence chest tube output

“…We are grateful for the interest shown in our study in which we aimed to analyze factors associated with increased bleeding following coronary artery bypass grafting (CABG) surgery. 1 Inherited bleeding disorders require careful planning and supplementation of factors before cardiac operations. Reports on hemophilia patients in cardiac surgery suggest no higher chest-tube output when given appropriate substitution therapy compared to non-hemophilia patients.…”