Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study:No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomiz

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概要

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• Although in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, detailed knowledge of fibrinolysis during various settings of coronary surgery is still limited. Sixty-five patients scheduled for coronary surgery were randomized into 3 groups: group A - conventional coronary artery bypass grafting, group B - off-pump surgery, and group C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of reinfusion of cardiotomy blood into the circuit. The sampling time points for rotation thromboelastographic evaluations were as follows: preoperatively, 15 minutes after sternotomy, on the completion of peripheral bypass anastomoses, at the end of the procedures, and 24 hours after the end of surgery. D-dimer levels were evaluated before surgery, at the end of procedures, and 24 hours after surgery. Thromboelastographic signs of fibrinolysis (evaluated by Lysis Onset Time-intergroup differences at 60 and 150 minutes of assessment: P = 0.003 and P < 0.001, respectively) were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C. At the other sampling times all thromboelastographic parameters were similar in all groups. In group A, no exceptional bleeding tendency (during 24 hours), as compared to groups B and C (geometric means and 95% confidence intervals: group A: 686.7 [570.8; 826.1] mL, group B: 555.3 [441.3; 698.9] mL, group C: 775.6 [645.1; 932.3] mL, P = 0.157), and no significant correlations between Lysis Onset Time, postoperative blood loss, and D-dimer levels were found. No significant differences in postoperative blood loss related to cardiac surgeons and assistant surgeons were detected. Thromboelastographic signs of increased fibrinolysis were detectable in the important proportion of coronary surgery patients operated on with the use of conventional cardio-pulmonary bypass, but not in off-pump patients and those operated on with the biocompatible surface-modified circuit without reinfusion of cardiotomy suction blood. These signs resolved spontaneously at the end of surgery and were not associated with increased postoperative bleeding. No significant correlation with D-dimer levels was found.

• International Heart Journal刊行会の論文

著者

• Snircova Jana

  Department of Cardiac Surgery, Third Faculty of Medicine, Charles University in Prague, Kralovske Vinohrady University Hospital

• Maly Marek

  Department of Biostatistics and Informatics, National Institute of Public Health

• Vanek Tomas

  Department of Cardiac Surgery, 3rd Medical School of Charles University, and Kralovske Vinohrady University Hospital

• Jares Martin

  Department of Cardiac Surgery, 3rd Medical School of Charles University, and Kralovske Vinohrady University Hospital

• Straka Zbynek

  Department of Cardiac Surgery, 3rd Medical School of Charles University, and Kralovske Vinohrady University Hospital

• Spegar Jan

  Department of Cardiac Surgery, Third Faculty of Medicine, Charles University in Prague, Kralovske Vinohrady University Hospital

関連論文

• Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study:Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective
• Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study:No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomiz
• Development of C-reactive Protein and Fibronectin Levels in Coronary Surgery Patients.:A Comparison of On-pump, Off-pump Sternotomy and Off-pump Left Anterior Small Thoracotomy Groups
• Use of Recombinant Activated Factor VII in Cardiac Surgery for an Effective Treatment of Severe Intractable Bleeding

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