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

Abstract

Introduction: Excessive bleeding (EB) after cardiopulmonary bypass (CPB) may lead to increased mortality, morbidity, transfusion requirements and re-intervention. Less than 50% of patients undergoing re-intervention exhibit surgical sources of bleeding. We studied clinical and genetic factors associated with EB.

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

“…Our results are consistent with several recent investigations showing that activation of the fibrinolytic system is associated with increased postoperative bleeding in cardiac surgery employing CPB [1,5,12]. …”

“…Our results indicated that those presenting with higher preoperative plasma concentrations of PAI-1 had less blood loss, and conversely, those with a lower preoperative plasma level had a larger blood loss 24 hours after surgery. Other investigators have noticed similar results [1,24]. Recently, investigators have reported favorable effects of administration of very long half-life PAI-1 (> 700 hours) on bleeding time and total blood loss after tail clip in PAI-1 deficient mice [25].…”

“…Several recent studies have described the influence of genetic factors, such as PAI-1 promoter – 675 (4G/5G) polymorphism, on the plasma levels of PAI-1, t-PA and t-PA/PAI-1 complex [1,4,6,17-20]. The 5G allele is associated with low levels of PAI-1 [4,6,17,19].…”

“…Alterations in hemostasis per - and postoperatively may have a diversity of etiologies. These include the surgery per se as well as effects of the cardiopulmonary bypass (CPB) on the coagulation and the inflammation cascades, and their cross-reactions with the fibrinolytic – and the kinin-kallikrein systems [1-3]. During the last few years, increasing attention has been paid to reports demonstrating the influence of the fibrinolytic system on increased bleeding, particularly after cardiac surgery employing CPB [1,4-6].…”

Multiple electrode aggregometry – only for cardiologists?

“…Platelet function monitoring plays an important role in balancing between the risk of thrombotic events (characteristic for antiplatelet therapy resistance) and perioperative bleeding. Surgeries requiring a cardiopulmonary bypass are often complicated by perioperative massive bleeding which results in increased mortality, morbidity, transfusion requirements and reinterventions [16]. Here the hopes for using MEA start, as this POCT method seems to be a useful device for assessing the risk of postoperative hemorrhage by performing ASPI-and ADP-tests mentioned earlier [17].…”