The association of thrombin generation with bleeding outcomes in cardiac surgery: a prospective observational study

Abstract

Background Cardiac surgery with cardiopulmonary bypass (CPB) is associated with coagulopathic bleeding. Impaired thrombin generation may be an important cause of coagulopathic bleeding but is poorly measured by existing hemostatic assays. We examined thrombin generation during cardiac surgery, using calibrated automated thrombography, and its association with bleeding outcomes. MethodsWe conducted a prospective observational study in 100 patients undergoing cardiac surgery with CPB. Calibrated automated thrombography parameters were expressed as a ratio of post-CPB values divided by pre-CPB values. The association of thrombin generation parameters for bleeding outcomes was compared with conventional tests of hemostasis, and the outcomes of patients with the most severe post-CPB impairment in thrombin generation (C 80% drop from baseline) were compared with the rest of the cohort. Results All 100 patients were included in the final analysis, with a mean age of 63 (12) yr, 31 (31%) female, and 94 (94%) undergoing bypass and/or valve

Assessment of Rotational Thromboelastometry and Thrombin Generation Assay to Identify Risk of High Blood Loss and Re-Operation After Cardiac Surgery

“…A ratio of 0.2 of ETP measured at post-CPB versus pre-CPB has been shown to be significantly associated with chest drain output. 11 In our study, no significant relationship was found between the post-CPB/pre-CPB ETP ratio and post-operative blood loss. Instead, the T4/T1 ratio of MCF-EXTEM values and the T1/T4 ratio of CFT-EXTEM values differentiated patients with high and low blood loss.…”