Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study

Pereira, Kárla M. F. S. M.; Assis, Caroline S. de; Cintra, Haulcionne N. W. L.; Ferretti-Rebustini, Renata Eloah de Lucena; Püschel, Vilanice Alves de Araújo; Santana–Santos, Eduesley; Rodrigues, Adriano Rogério Baldacin; Oliveira, Larissa Bertacchini de

doi:10.1111/jocn.14670

Cited by 8 publications

(6 citation statements)

References 36 publications

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“…Lower preoperative platelet counts were shown to increase bleeding in previous studies 11,13 . The CPB has well‐documented detrimental effects on platelets both by consumption and impaired function 14 .…”

Section: Discussionmentioning

confidence: 88%

“…The HAS‐BLED score has been found to correlate with bleeding within 90 days of cardiac surgery but not with bleeding within 48 h 10 . The risk profile of CABG patients can vary between institutions as well as the perioperative practices that influence bleeding 11 . The demographic differences of the patient populations can also influence the associated risk factors across institutions.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…A FC mais elevada no período intraoperatório foi maior no grupo de pacientes reoperados. Estudo que avaliou as variáveis relacionadas ao sangramento excessivo no pós-operatório de cirurgia cardíaca identificou a frequência cardíaca elevada como um preditor desse sintoma (21) . A diminuição do volume sistólico como consequência da perda sanguínea, que caracteriza os pacientes submetidos a reoperação, pode ser a explicação para a frequência cardíaca mais elevada.…”

Section: Discussionunclassified

Fatores associados à reoperação por sangramento e desfechos após cirurgia cardíaca: estudo de coorte prospectivo

Rodrigues

Benevides

Crespo

et al. 2022

Rev. esc. enferm. USP

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RESUMO Objetivo: Identificar a incidência e os fatores associados à reoperação devido sangramento no pós-operatório de cirurgia cardíaca, além dos desfechos clínicos dos pacientes. Método: Estudo de coorte prospectivo, realizado em Unidade de Terapia Intensiva (UTI), com pacientes adultos submetidos à cirurgia cardíaca. Foram excluídos pacientes com diagnóstico de coagulopatias. Os pacientes foram acompanhados desde a internação até a saída hospitalar. Resultados: Foram incluídos 682 pacientes e a incidência de reoperação foi 3,4 %. Os fatores associados à reoperação foram: histórico de insuficiência renal (p = 0,005), uso prévio de anticoagulante (p = 0,036), maior frequência cardíaca intraoperatória (p = 0,015), necessidade de transfusão de hemocomponentes no intraoperatório (p = 0,040) e maior pontuação no SAPS 3 (p < 0,001). Os desfechos associados a reoperação foram: acidente vascular encefálico e parada cardiorrespiratória. Conclusão: A reoperação foi um evento associado a maior gravidade, disfunção orgânica, e piores desfechos clínicos, porém não houve diferença de mortalidade entre os grupos.

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“…However, there are other mechanisms responsible for the appearance of hyperlactatemia in the intraoperative period of cardiac surgery with ECC: (1) the duration of surgery with ECC, with a relationship directly proportional to the time of surgery [10,33], and (2) a deficit in oxygen intake and consumption as well as an increase in its extraction [28] as they affect the morbidity of these patients, especially when lactate levels are higher than 4 mmol/L [7]. Nonetheless, the results obtained show that high-volume hemofiltration pursues a zero balance at the end of ECC, managing to mitigate the presence of high amounts of lactate regardless of sex and previous pathologies in patients during the preoperative period as well as the duration of ECC.…”

Section: Discussionmentioning

confidence: 99%

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

et al. 2020

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Introduction Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. Materials and methods This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. Results Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. Conclusions The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.

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Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study

Abstract: Knowledge of the factors associated with the increased bleeding is critical for nurses so they can provide prophylactic interventions and early postoperative treatment when needed.

Cited by 8 publications

References 36 publications

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

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

Fatores associados à reoperação por sangramento e desfechos após cirurgia cardíaca: estudo de coorte prospectivo

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

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