Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study.

Abstract

INTRODUCTION:

Excessive bleeding (EB) after cardiopulmonary bypass (CPB) may lead to increased mortality, morbidity, transfusion requirements and re-intervention. Less than 50% of patients undergoing re-intervention exhibit surgical sources of bleeding. We studied clinical and genetic factors associated with EB.

METHODS:

We performed a nested case-control study of 26 patients who did not receive antifibrinolytic prophylaxis. Variables were collected preoperatively, at intensive care unit (ICU) admission, at 4 and 24 hours post-CPB. EB was defined as 24-hour blood loss of > 1 l post-CPB. Associations of EB with genetic, demographic, and clinical factors were analyzed, using SPSS-12.2 for statistical purposes.

RESULTS:

EB incidence was 50%, associated with body mass index (BMI) < 26.4 (25-28) Kg/m2, (P = 0.03), lower preoperative levels of plasminogen activator inhibitor-1 (PAI-1) (P = 0.01), lower body temperature during CPB (P = 0.037) and at ICU admission (P = 0.029), and internal mammary artery graft (P = 0.03) in bypass surgery. We found a significant association between EB and 5G homozygotes for PAI-1, after adjusting for BMI (F = 6.07; P = 0.02) and temperature during CPB (F = 8.84; P = 0.007). EB patients showed higher consumption of complement, coagulation, fibrinolysis and hemoderivatives, with significantly lower leptin levels at all postoperative time points (P = 0.01, P < 0.01 and P < 0.01).

CONCLUSION:

Excessive postoperative bleeding in CPB patients was associated with demographics, particularly less pronounced BMI, and surgical factors together with serine protease activation.

• Authors: Juan J Jimenez Rivera, Jose L Iribarren, Jose M Raya, Ibrahim Nassar, Leonardo Lorente, Rosalia Perez, Maitane Brouard, Jose M Lorenzo, Pilar Garrido, Ysamar Barrios, Maribel Diaz, Blas Alarco, Rafael Martinez, Maria L Mora
• Journal: Journal of cardiothoracic surgery (J Cardiothorac Surg) Vol. 2 Pg. 17 (Apr 10 2007) ISSN: 1749-8090 [Electronic] England
• PMID: 17425777 (Publication Type: Journal Article)

Chemical References

• Complement C3
• Leptin
• Plasminogen Activator Inhibitor 1

Topics

• Adult
• Aged
• Blood Chemical Analysis
• Blood Coagulation (physiology)
• Cardiopulmonary Bypass (adverse effects, methods)
• Case-Control Studies
• Complement C3 (metabolism)
• Enzyme-Linked Immunosorbent Assay
• Female
• Fibrinolysis (physiology)
• Follow-Up Studies
• Hospital Mortality (trends)
• Humans
• Intensive Care Units
• Leptin (blood)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Plasminogen Activator Inhibitor 1 (metabolism)
• Postoperative Care
• Postoperative Hemorrhage (diagnosis, mortality, therapy)
• Preoperative Care
• Probability
• Risk Assessment
• Severity of Illness Index
• Statistics, Nonparametric
• Survival Analysis