Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients
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Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients. / Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F; Olsen, Peter Skov; Steinbrüchel, Daniel A.
In: Journal of Cardiac Surgery, Vol. 31, No. 9, 09.2016, p. 565-71.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients
AU - Rafiq, Sulman
AU - Johansson, Pär I
AU - Kofoed, Klaus F
AU - Olsen, Peter Skov
AU - Steinbrüchel, Daniel A
N1 - © 2016 Wiley Periodicals, Inc.
PY - 2016/9
Y1 - 2016/9
N2 - BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery.METHODS: A total of 170 patients were enrolled in this prospective observational study. TEG, Multiplate aggregometry, and coagulation tests were sampled on the day before surgery. Excessive bleeding was defined as >1000 mL over 18 hours.RESULTS: Multiplate-adenosine diphosphate (ADP) measurements were significantly lower in patients with excessive bleeding, 85.5AU ± 32.8 versus 108.5AU ± 30.0, p = 0.012. Bivariate analysis revealed body mass index, myocardial infarction, and multiplate-ADP as predictors of bleeding. In multivariable linear regression analysis, multiplate-ADP remained a significant predictor of bleeding (β: -6.2 [confidence interval: -12.0 to -0.3], p = 0.035). The lowest interval of multiplate-ADP (<50 AUC) was associated with significantly more bleeding and need for platelet concentrate transfusion. Fibrinogen levels <2.5 g/L were also found to be associated with excess bleeding (p = 0.020).CONCLUSIONS: Multiplate impedance aggregometry identified patients at risk for excessive bleeding after CABG. Low fibrinogen levels were associated with increased bleeding. Neither routine TEG parameters nor conventional coagulation tests were correlated with bleeding.
AB - BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery.METHODS: A total of 170 patients were enrolled in this prospective observational study. TEG, Multiplate aggregometry, and coagulation tests were sampled on the day before surgery. Excessive bleeding was defined as >1000 mL over 18 hours.RESULTS: Multiplate-adenosine diphosphate (ADP) measurements were significantly lower in patients with excessive bleeding, 85.5AU ± 32.8 versus 108.5AU ± 30.0, p = 0.012. Bivariate analysis revealed body mass index, myocardial infarction, and multiplate-ADP as predictors of bleeding. In multivariable linear regression analysis, multiplate-ADP remained a significant predictor of bleeding (β: -6.2 [confidence interval: -12.0 to -0.3], p = 0.035). The lowest interval of multiplate-ADP (<50 AUC) was associated with significantly more bleeding and need for platelet concentrate transfusion. Fibrinogen levels <2.5 g/L were also found to be associated with excess bleeding (p = 0.020).CONCLUSIONS: Multiplate impedance aggregometry identified patients at risk for excessive bleeding after CABG. Low fibrinogen levels were associated with increased bleeding. Neither routine TEG parameters nor conventional coagulation tests were correlated with bleeding.
KW - Aged
KW - Biomarkers
KW - Blood Coagulation Tests
KW - Coronary Artery Bypass
KW - Female
KW - Fibrinogen
KW - Hemorrhage
KW - Humans
KW - Male
KW - Middle Aged
KW - Platelet Aggregation
KW - Platelet Function Tests
KW - Postoperative Complications
KW - Predictive Value of Tests
KW - Preoperative Period
KW - Prospective Studies
KW - Risk
KW - Thrombelastography
KW - Journal Article
U2 - 10.1111/jocs.12807
DO - 10.1111/jocs.12807
M3 - Journal article
C2 - 27445266
VL - 31
SP - 565
EP - 571
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
SN - 0886-0440
IS - 9
ER -
ID: 176952170