Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Abstract

Objective: To determine predictors of postoperative bleeding after cardiac surgery, in order to focus on preventive measures for high-risk populations.Methods: From October 2001 to March 2002, 411 consecutive adult cardiac surgery patients were prospectively studied, with the exception of those submitted to heart transplantation. In order to determine risk factors for postoperative bleeding, 20 preoperative, 17 operative and 6 postoperative variables were analyzed using univariate methods and multiple linear regression.Results: Operative procedures included coronary artery bypass grafting in 227 (55.2%) patients, valvar operations in 198 (48.2%), aortic surgery in 25 (6.1%) and combined procedures in 60 (14.6%). Cardiopulmonary bypass was used in 335 (81.5%) patients and anti-fibrinolysis agents in 148 (36%). The thirty-day mortality rate was 5.6% (23 patients). Mean 24-hour postoperative blood loss was 610 ± 500 mL (range 10-4900). Re-exploration for bleeding was required in 15 (3.7%) patients. Independent predictors of postoperative bleeding were emergency operations (p=0.049), postoperative metabolic acidosis (p=0.001), preoperative thrombocytopenia (p=0.034) and prolonged cardiopulmonary bypass (p=0.021).Conclusions: When possible, preoperative stabilization and correction of coagulation disturbances should be achieved in patients requiring urgent or emergent surgery and in those with thrombocytopenia. The duration of cardiopulmonary bypass should be minimized as long as this is practical. Postoperative metabolic acidosis must be actively corrected, especially the main determining causes. Descriptors

Deep sternal wound infection after cardiac surgery

“…In our study, the incidence of re-exploration for bleeding in DSWI cases was 11.1% and it was threefold as many as overall incidence of re-exploration for bleeding. Patients requiring resternotomy are at greater risk from the hazards of transfusion reactions, viral infections, suppression of the immune system [9,10]. Canadyova et al described that risk factors associated with higher in-hospital mortality after re-exploration for bleeding and tamponade include delayed resternotomy, higher levels of lactate, lower levels of hematoclit before revision, older age, more complex cardiac procedures, redo operations, longer cardiopulmonary bypass, renal failure and diabetes mellitus.…”

Hemangioma intra-atrial esquerdo

“…The study of predisposing factors for the bleeding after heart surgery [6], with an increase of the transfusional requirements, is related to preoperative thrombocytopenia and CPB use (mainly prolonged CPB with hypothermia). In the present report, the increased bleeding, attributed principally to the thrombocytopenia with aggravation due to the use of CPB (although for a short time and without deep hypothermia), was corrected with platelet replacement.…”

Influência do ácido épsilon aminocapróico no sangramento e na hemotransfusão pós-operatória em cirurgia valvar mitral

“…The risks associated with blood transfusion and its components have encouraged the search for pharmacological agents capable of reducing blood loss as a result of CPB [6][7].…”

“…The effectiveness of the preventive regimen with aprotinin has been thoroughly demonstrated in literature. The high cost of the product and the various adverse effects have stimulated the search for alternatives of equal efficacy and lower costs [6][7][8][9][10][11].…”