Bleeding risk assessment using whole blood impedance aggregometry and rotational thromboelastometry in patients following cardiac surgery
| العنوان: | Bleeding risk assessment using whole blood impedance aggregometry and rotational thromboelastometry in patients following cardiac surgery |
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| المؤلفون: | Lucija Svetina, Sanja Konosić, Bojan Biocina, Davor Miličić, Ante Lekić, Hrvoje Gasparovic, Ivan Burcar, Boris Zdilar, Milan Milošević, Rifat Brahimaj, Jure Samardzic, Mate Petricevic |
| المصدر: | Journal of Thrombosis and Thrombolysis. 36:514-526 |
| بيانات النشر: | Springer Science and Business Media LLC, 2013. |
| سنة النشر: | 2013 |
| مصطلحات موضوعية: | Adult, Male, Excessive Bleeding, medicine.medical_specialty, Postoperative Hemorrhage, Disease-Free Survival, law.invention, law, Internal medicine, Electric Impedance, medicine, Cardiopulmonary bypass, Coagulopathy, Humans, Prospective Studies, Cardiac Surgical Procedures, Aged, Whole blood, Aged, 80 and over, Hematology, business.industry, Middle Aged, Bleed, medicine.disease, Thrombelastography, Surgery, Cardiac surgery, Survival Rate, Thromboelastometry, Multiple electrode aggregometry, Rotational thromboelastometry, Bleeding risk, Transfusion, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies |
| الوصف: | Excessive bleeding after cardiopulmonary bypass (CPB) is risk factor for adverse outcomes after elective cardiac surgery (ECS). Differentiating between patients who bleed due to surgical issues and those whose excessive chest tube output (CTO) is due to coagulopathy, remains challenging. Bedside suitable tests to identify hemostatic disturbances and predict excessive bleeding are desirable. The study sought to evaluate prediction of excessive bleeding after ECS using two bedside suitable devices for platelet function and visco- elastic blood clot properties assessment. We enrolled 148 patients (105 male and 43 female) undergoing ECS in a prospective observational study. Patients were character- ized as bleeders if their 24 h CTO exceeded the 75th percentile of distribution. Multiple electrode aggregom- etry (MEA, with ASPI, ADP and the TRAP test) and rotational thromboelastometry (TEM, with ExTEM, HepTEM and FibTEM test), were performed at three time points: preoperatively (T1), during CPB (T2), and after protamine administration (T3). The primary end- point was CTO and the secondary endpoint was admin- istration of blood products, 30-day and 1 year mortality. The best predictors of increased bleeding tendency were the tests performed after protamine administration (T3). At T3, patients characterized as bleeders had signifi- cantly lower MEA ASPI (median, 14 vs. 27 AUC, p = 0.004) and ADP test values (median, 22 vs. 41 AUC, p = 0.002) as well as TEM values expressed in maximum clot firmness after 30 min (MCF 30) for ExTEM (53 vs. 56 mm, p = 0.005), HepTEM (48 vs. 52 mm, p = 0.003) and FibTEM (8 vs. 11 mm, p \ 0.001) test. 24 h CTO inversely correlated with both the MEA (ASPI test: r =- 0.236, p = 0.004; ADP test: r =- 0.299, p \ 0.001), and TEM MCF 30 (ExTEM: r =- 0.295, p \ 0.001; HepTEM: -0.329, p \ 0.001; FibTEM: -0.377, p \ 0.001) test values. Our study showed that MEA and TEM are useful methods for prediction of excessive bleeding after ECS. In order to prevent excessive postoperative CTO, hemostatic inter- ventions with timely and targeted blood component therapy according to MEA and TEM results should be considered. |
| وصف الملف: | application/pdf |
| تدمد: | 1573-742X 0929-5305 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::deb9671519073770039a3fed5100ffb4 https://doi.org/10.1007/s11239-013-0868-1 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....deb9671519073770039a3fed5100ffb4 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 1573742X 09295305 |
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