A Snapshot of Coagulopathy After Cardiopulmonary Bypass

Clinical and Applied Thrombosis/Hemostasis - Tập 22 Số 6 - Trang 505-511 - 2016
Judith Höfer1, D Friès2, Marco Ranucci3,4,5, Corinna Velik‐Salchner1, Julia Ausserer1
1Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
2Department of Surgical and General Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
3CSL Behring, Marburg, Germany
4Department of Anesthesiology, Perioperative Care and General Intensive Care, Paracelsus Medical University, Salzburg University Hospital, Salzburg, Austria
5Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria

Tóm tắt

Cardiac surgery involving cardiopulmonary bypass (CPB) is often associated with important blood loss, allogeneic blood product usage, morbidity, and mortality. Coagulopathy during CPB is complex, and the current lack of uniformity for triggers and hemostatic agents has led to a wide variability in bleeding treatment. The aim of this review is to provide a simplified picture of the data available on patients’ coagulation status at the end of CPB in order to provide relevant information for the development of tailored transfusion algorithms. A nonsystematic literature review was carried out to identify changes in coagulation parameters during CPB. Both prothrombin time and activated partial thromboplastin time increased during CPB, by a median of 33.3% and 17.9%, respectively. However, there was marked variability across the published studies, indicating these tests may be unreliable for guiding hemostatic therapy. Some thrombin generation (TG) parameters were affected, as indicated by a median increase in TG lag time of 55.0%, a decrease in TG peak of 17.5%, and only a slight decrease in endogenous thrombin potential of 7%. The most affected parameters were fibrinogen levels and platelet count/function. Both plasma fibrinogen concentration and FIBTEM maximum clot firmness decreased during CPB (median change of 36.4% and 33.3%, respectively) as did platelet count (44.5%) and platelet component (34.2%). This review provides initial information regarding changes in coagulation parameters during CPB but highlights the variability in the reported results. Further studies are warranted to guide physicians on the parameters most appropriate to guide hemostatic therapy.

Từ khóa


Tài liệu tham khảo

10.1111/j.1365-3148.2006.00709.x

10.1097/ACO.0b013e32835ddca6

10.1007/s00134-004-2388-0

10.1111/bjh.12746

O’Carroll-Kuehn BU, 2007, Crit Care Pain, 7, 195

10.1213/ANE.0b013e3182354b7e

10.1111/anae.12898

10.1001/jama.2010.1406

10.1016/j.jtcvs.2013.10.051

10.1016/0002-9343(93)90086-5

10.1016/S1053-0770(97)90247-0

10.1160/TH13-12-0997

10.1111/jth.12045

10.1111/j.1538-7836.2009.03412.x

Ho AM, 2003, Anesth Analg, 96, 15, 10.1213/00000539-200301000-00005

10.1111/jth.12351

Food and Drug Administration. Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual Summary for Fiscal Year 2012. Web site. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm346639.htm. Accessed March 2016.

10.1111/j.1537-2995.2010.02816.x

10.1532/HSF98.20071065

10.1160/TH04-12-0799

10.1177/0310057X0002800411

10.1016/j.thromres.2014.05.008

Hiippala ST, 1995, Anesth Analg, 81, 360

10.1097/EJA.0b013e32835f4d5b

10.1097/ALN.0b013e3182715d4d

10.1111/j.1538-7836.2007.02481.x

10.7326/M14-1589

10.1016/j.thromres.2010.05.028

10.1213/ANE.0b013e3181db7991

10.1016/j.thromres.2011.02.022

10.1097/00000542-199802000-00009

Thông tin
Thông tin xuất bản

Clinical and Applied Thrombosis/Hemostasis

Tập 22 Số 6

505-511

Thông tin tác giả