Measurement of thrombin generation intra-operatively and its association with bleeding tendency after cardiac surgery.

Autor: Bosch YP; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht. Electronic address: yvonne.bosch@mumc.nl., Al Dieri R; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., ten Cate H; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., Nelemans PJ; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., Bloemen S; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., de Laat B; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., Hemker C; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., Weerwind PW; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., Maessen JG; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht., Mochtar B; Maastricht University Medical Center(+), Cardiovascular Research Institute Maastricht.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2014 Mar; Vol. 133 (3), pp. 488-94. Date of Electronic Publication: 2013 Dec 19.
DOI: 10.1016/j.thromres.2013.12.017
Abstrakt: Introduction: Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are susceptible to haemostatic disturbances. Monitoring the haemostatic capacity by conventional clotting tests is challenging.
Materials and Methods: Thrombin generation (TG) by Calibrated Automated Thrombography, clotting tests and tissue factor pathway inhibitor (TFPI) measurements were performed to describe the relationship between haemostatic changes and alterations in these tests. Blood samples were collected before, during and after CPB. Furthermore, it was investigated whether TG measured intraoperatively, is associated with increased risk of bleeding postoperatively.
Results: TG diminished significantly (p<0.01) after heparinization in the presence and absence of platelets (37% and 50%) compared to baseline. After the start of CPB, TG elevated and persisted till the end of surgery but remained lower than preoperatively. Activated clotting time increased after heparinization and after the start of bypass compared to baseline (400% and 500%). Anti-FXa activity reduced on the start of CPB compared to the level after heparinization, to almost the baseline value following protamine reversal of heparin. The plasma levels of total and free TFPI elevated 9 and 14 fold during bypass and remained after protamine administration higher than preoperatively. Plasma D-dimer levels reduced (p<0.01) when bypass started. However, a marked elevation was observed in the following time points. TG in platelet-rich plasma measured after heparinization and after the start of CPB associated (p<0.05) with postoperative blood loss.
Conclusions: TG can be determined during CPB despite the high heparinization level, it reflects the haemostatic capacity better than clotting-based assays and might better predict bleeding when performed intraoperatively.
(Copyright © 2013 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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