Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery

Abstract

We investigated the relationship between factor XIII, fibrinogen, blood coagulation screening tests and postoperative bleeding in 98 patients undergoing cardiopulmonary bypass (CPB) surgery. All patients received aprotinin. Blood samples were collected preoperatively (T1),after termination of CPB (T2),12 h (T3) and 24 h (T4) after surgery to determine FXIII activity, fibrinogen, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT) and D-dimers (DD). Laboratory results were correlated with the chest tube drainage 24 h after surgery and compared between patients with 24-hour chest tube drain volumes in the lower (Group 1) with those in the upper tertile (Group 3). Median FXIII and fibrinogen levels dropped by 33.9% and 34.2%, respectively, during CPB. No association between FXIII activity and the extent of postoperative bleeding was found. However, chest tube bleeding was significantly correlated with preoperative and postoperative fibrinogen. This was confirmed by comparing Groups 1 and 3. Group 3 patients had significantly lower fibrinogen levels than Group 1 at T1 - T4, although most fibrinogen values were within or above the reference range (medians, g/l: 3.5 vs. 4.0, p = 0.043 at T1; 2.3 vs. 2.7, p = 0.015 at T2; 2.9 vs. 3.3, p = 0.008 at T3; 4.2 vs. 5.2, p = 0.002 at T4). There was also a significant relationship of platelet count, PT and APTT, as measured after CPB (T2), with postoperative chest tube drainage. In conclusion, plasma FXIII activity does not influence postoperative bleeding in patients undergoing CPB surgery. There is however an inverse association between preoperative or postoperative plasma fibrinogen levels and postoperative bleeding. These findings indicate a modulation of postoperative bleeding by fibrinogen levels.

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.…”

“…Consumption of coagulation factors has been well described in cardiac surgery, 30,46,47 as has the dilution of factors resulting from red cell transfusion and volume expanders. In addition, altered blood flow during CPB might have resulted in decreased synthetic function of coagulation factors by the liver.…”

Audit of factor VIIa for bleeding resistant to conventional therapy following complex cardiac surgery

“…14,15 The pathophysiology of post bypass bleeding, particularly in complex cardiac surgery, is incompletely understood, but appears to be multifactorial, with platelet dysfunction and decreased fibrinogen concentrations playing important roles. [15][16][17] Australian transfusion guidelines 14 suggest that cryoprecipitate may be indicated when bleeding is associated with decreased fibrinogen, and that fresh frozen plasma may be indicated for bleeding after cardiac surgery. Our guideline recommends platelet and cryoprecipitate transfusion in response to decreases in platelets and fibrinogen concentrations in lieu of using fresh frozen plasma alone.…”

Perioperative Administration of Fibrinogen is Associated with Increased Risk of Postoperative Thromboembolic Complications after Cardiac Surgery

“…It is converted in plasma by thrombin into a fibrin clot at the site of tissue damage in order to minimize blood loss and initiate tissue repair [9]. Administration of prophylactic fibrinogen has been shown to reduce postoperative bleeding after coronary artery bypass graft (CABG) [10] and previous studies have reported an inverse correlation between preoperative concentration of fibrinogen in plasma and the volume of postoperative bleeding after CABG [11][12][13][14][15]. This indicates that preoperative fibrinogen plasma concentration, even within the normal range, is a limiting factor for haemostasis after cardiac surgery.…”