The prothrombotic paradox of severe obesity after cardiac surgery under cardiopulmonary bypass

Kindo, Michel; Minh, Tam Hoang; Gerelli, Sébastien; Meyer, Nicolás; Schaeffer, Mickaël; Perrier, Stéphanie; Bentz, Jonathan; Announe, Tarek; Mommerot, Arnaud; Collange, Olivier; Marguerite, Sandrine; Thibaud, A.; Gros, Hubert; Billaud, Philippe; Mazzucotelli, Jean‐Philippe

doi:10.1016/j.thromres.2014.06.008

Cited by 14 publications

(9 citation statements)

References 44 publications

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“…Moreover, discontinuation of antiplatelet therapy may induce the release of some proarrhythmic platelet activation compounds [34]. We previously found that antiplatelet therapy is an independent risk factor of excessive postoperative bleeding and red blood cell transfusion [35]. Others have speculated that red blood cell transfusion is a risk factor of AF after cardiac operations [5].…”

Section: Commentmentioning

confidence: 99%

Predictors of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Bayesian Analysis

Perrier

Meyer²,

Minh

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Predictors of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Bayesian Analysis

Perrier

Meyer²,

Minh

et al. 2017

The Annals of Thoracic Surgery

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“…16 Several investigators found a high correlation of less need for blood transfusion among obese patients and a suggestion of reduced postoperative bleeding in patients undergoing cardiac surgery and CPB. 17 Adipose tissues have been found to contain increased estrogens that have a variety of procoagulant effects on the coagulation system that might explain the decrease in bleeding. 7,8,17 Most obese patients have high concentrations of circulating leptin which is known to suppress food intake and increase energy expenditure.…”

Section: Discussionmentioning

confidence: 99%

“…17 Adipose tissues have been found to contain increased estrogens that have a variety of procoagulant effects on the coagulation system that might explain the decrease in bleeding. 7,8,17 Most obese patients have high concentrations of circulating leptin which is known to suppress food intake and increase energy expenditure. Leptin also promotes human platelet aggregation which has been suggested as a mechanism for acute thrombotic events in obesity.…”

Section: Discussionmentioning

confidence: 99%

A BMI >35 does not protect patients undergoing cardiac bypass surgery from red blood cell transfusion

Mongero¹,

Tesdahl²,

Stammers³

et al. 2016

Perfusion

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The effect of obesity on allogeneic intraoperative blood product transfusion in patients undergoing coronary artery bypass graft surgery (CABG) is poorly understood. We analyzed the influence of obesity on the risk of intraoperative red blood cell (RBC) transfusion among 45,200 consecutive non-reoperative CABG procedures from a multi-institutional perfusion database. A body mass index (BMI) in obese I category was associated with a 9.9% decrease in transfusion risk (p<0.05). Compared to patients with a normal BMI, obese I and obese III patients do not have any change in the relative risk of RBC transfusion. Overweight and mild obesity have a protective role in reducing intraoperative blood transfusion during cardiopulmonary bypass (CPB) surgery. However, logistic regression analysis showed that much of the observed reduction in transfusion rates for obese patients can be accounted for by other known confounds. The lack of a linear effect of increasing BMI on blood transfusion risk is a novel finding and warrants further investigation.

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“…A preoperative factor is a high score of CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65–74 y, Sex category [female sex], obesity, withdrawal of beta-blockers, left atrial enlargement, left ventricular dysfunction, history of AF or other arrhythmias, chronic obstructive pulmonary disease, high cholesterol, chronic kidney disease, intra-aortic balloon pump usage, intraoperative inotrope use, and hypomagnesemia. 6 , 8 - 11 Postoperative AF is less common after isolated CABG than valvular or combined CABG and valvular surgery. 10 , 12 Some studies have demonstrated a genetic predisposition as a risk factor for postoperative AF.…”

Section: Introductionmentioning

confidence: 99%

“…The reported incidence rates of postoperative AF are variable and range from 15% to 40%. 1 , 8 Postoperative AF may cause different major and minor complications such as myocardial infarction, respiratory failure, stroke, decreased short-term and long-term survival, higher costs of treatment, and longer lengths of hospital and intensive care unit (ICU) stay. 11 , 14 - 16 Considering age as the main predictor of postoperative AF and the incremental trend of the age of the patients needing CABG, the incidence of postoperative AF has been on the increase in the last decades.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation

Daie

Talasaz

Karimi

et al. 2019

JTHC

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Background: Postoperative atrial fibrillation (POAF) is probably a consequence of inflammation. Vitamin D is known for its anti-inflammatory properties. The aim of this study was to evaluate the effects of vitamin D levels on the incidence of POAF. Methods: In a prospective cohort study, patients were monitored for the occurrence of POAF during the first 5 days after coronary artery bypass grafting surgery in Tehran Heart Center. Those with concomitant valvular surgeries were excluded. Thereafter, they were divided into 2 groups: with or without POAF. Vitamin D levels were assessed in all the patients. The relationship between the vitamin D level and the incidence of POAF was evaluated and compared between the groups using the Mann–Whitney U test. Results: The study population comprised of 156 patients. The mean age was 62.8±8.6 years, and 105 (67.3%) patients were male. Of the 156 patients, 29 (19%) developed POAF. The median preoperative vitamin D level was 15.3 in the group with POAF and 25.3 in the group without POAF (P=0.07). Conclusion: Our results demonstrated no significant relationship between vitamin D levels and the occurrence of POAF.

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The prothrombotic paradox of severe obesity after cardiac surgery under cardiopulmonary bypass

Cited by 14 publications

References 44 publications

Predictors of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Bayesian Analysis

Predictors of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Bayesian Analysis

A BMI >35 does not protect patients undergoing cardiac bypass surgery from red blood cell transfusion

Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation

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