Thrombocytopathies in Patients With Open-Heart Surgery

Holswade, George R.

doi:10.1001/archsurg.1967.01330090059015

Cited by 12 publications

(3 citation statements)

References 7 publications

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“…Another early study assessed platelet function before placing patients on CPB, but failed to evaluate platelet function during or after bypass. 106 In this study, abnormal preoperative platelet adhesion in glass bead columns was associated with increased postoperative bleeding. Salzman 166 studied platelet adhesion before, during, and after bypass and noted decreased adhesion to glass bead columns in all patients during bypass; however, the significance of this defect was difficult to evaluate, since all patients had marked thrombocytopenia, which is definitely known to alter adhesion studies, 36,57,58 and adhesion studies are generally thought to be without any clinical significance.…”

Section: Platelet Function Defectsmentioning

confidence: 58%

Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits

Bick¹

1985

Semin Thromb Hemost

204

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This discussion has provided a review of the available literature regarding alterations of hemostasis associated with CPB surgery, the use of prosthetic devices, and apheresis. The key to prevention of CPB hemorrhage is to obtain an adequate preoperative workup. Of extreme importance is an adequate history with respect to bleeding tendencies and thrombotic tendencies in both the patient and the family; of equal importance is a careful history regarding the use of drugs affecting hemostasis, especially drugs known to interfere with platelet function. A careful physical examination, searching for clues of a real or potential bleeding diathesis, may also prevent catastrophic cases of hemorrhage. An adequate presurgical screen must be performed in surgical patients. In addition to the usual prothrombin time, partial thromboplastin time, and platelet count, a standardized template bleeding time (and thrombin time in patients subjected to CPB) should be performed. The use of these simple testing modalities will guard against significant defects in vascular and platelet function. Most instances of nontechnical surgical and cardiovascular surgical hemorrhage are due to several well-defined defects in hemostasis that should be readily controlled if approached in a logical manner as a team effort among surgeons, pathologists, and hematologists.

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Section: Platelet Function Defectsmentioning

confidence: 58%

Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits

Bick¹

1985

Semin Thromb Hemost

204

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“…Early investigators [64] suspected development of abnormal platelet function during CPB, as faulty clot retraction was noted; these results were of unclear significance, however, since other abnormal parameters known to affect clot retraction, such as hypofibrinogenemia and thrombocytopenia, were also present. Another early study [36] assessed platelet adhesion before placing patients on CPB, but failed to evaluate platelet function during or after bypass. In this study, abnormal preoperative platelet adhesion was associated with increased postoperative bleeding.…”

Section: Thrombocytopeniamentioning

confidence: 99%

Alterations of Hemostasis Associated With Cardiopulmonary Bypass: Pathophysiology, Prevention, Diagnosis, and Management

Bick¹

2008

Semin Thromb Hemost

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“…reexploration following cardiac surgery which utilizes cardiopulmonary bypass [1][2][3][4][5][6][7][8][9][10][11][12]. Previous stud~es which have tried either to predict post-operatl,,:e hemorrhage or aid in defining the causes of th~s bleeding have had mixed results [13][14][15][16][17][18][19][20][21][22][23]. The pnmary weakness in these prior studies is the lack of differentiation of the two different patient populations, those with bleeding from surgical causes with mild coagulation defects and tho~e that h.ave a severe coagulopathy without a specific surgical source of bleeding.…”

Section: Introductionmentioning

confidence: 99%

Hemorrhage Related Reexploration following Open Heart Surgery: The Impact of Pre-Operative and Post-Operative Coagulation Testing

Hall

Sines

Spotnitz

2002

Cardiovascular Surgery

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Purpose: Our objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery. Methods: Retrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures. Results: Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients ( P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients ( P<0.05). Conclusions: Pre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.

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Thrombocytopathies in Patients With Open-Heart Surgery

Cited by 12 publications

References 7 publications

Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits

Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits

Alterations of Hemostasis Associated With Cardiopulmonary Bypass: Pathophysiology, Prevention, Diagnosis, and Management

Hemorrhage Related Reexploration following Open Heart Surgery: The Impact of Pre-Operative and Post-Operative Coagulation Testing

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