Predictive Value of Blood Clotting Tests in Cardiac Surgical Patients

Un temps de céphaline activée élevé n’est pas associé à un rebond d’héparine après une chirurgie cardiaque

“…[25][26][27][28][29][30][31][32][33][34] Some have found a positive correlation between APTT and postoperative hemorrhage following cardiac surgery. 26,28,30,[35][36][37][38][39] Very few studies, in fact, have specified their transfusion algorithms for the management of hemorrhage, [26][27][28]40 thus making it difficult to ascertain how elevated APTT was interpreted and dealt with in most studies.…”

Un petit peu de connaissances sur la coagulation peut s’avérer dangereux!

“…We have yet to understand the reason for that occurrence; however, it is fact that the INR-PT is often elevated after CPB (not considered abnormal until twofold or higher). 6 Following heart surgery, no patient, unless bleeding, should be treated with fresh frozen plasma (FFP) based on an INR-PT alone. The fact that both coagulation tests have parallel elevations signifies a single mechanism.…”

“…The majority of coagulation abnormalities after CPB are not found with ''routine tests''. 6,7 For example, tissue factor pathway inhibitor (TFPI) is released from endothelial cells due to unfractionated heparin usage as well as ischemia and reperfusion. 8 TFPI may account for some bleeding and its destruction could lead to thrombosis, yet we cannot track TFPI with routine testing.…”

“…6,10 This literature notes that these tests have no positive or negative predictive value either alone or in aggregate, yet they are still widely utilized. The aPTT and INR-PT tests were designed when the serine protease cascades were being discovered.…”

“…La raison de cette survenue nous est encore inconnue; toutefois, il est clair que l'INR-PT est souvent élevé après la CEC (il n'est pas considéré anormal avant d'être le double ou plus). 6 Après une chirurgie cardiaque, il ne faudrait traiter aucun patient, sauf s'il saigne, avec du plasma frais congelé (PFC) en se fondant uniquement sur un INR-PT. Le fait que les deux tests de coagulation montrent des élévations parallèles est indicateur d'un mécanisme unique.…”