| Autor: |
Rivera, Juan J. Jimenez, Iribarren, Jose L., Raya, Jose M., Nassar, Ibrahim, Lorente, Leonardo, Perez, Rosalia, Brouard, Maitane, Lorenzo, Jose M., Garrido, Pilar, Barrios, Ysamar, Diaz, Maribel, Alarco, Blas, Martinez, Rafael, Mora, Maria L. |
| Předmět: |
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| Zdroj: |
Journal of Cardiothoracic Surgery; 2007, Vol. 2, p17-7, 7p, 1 Chart, 2 Graphs |
| Abstrakt: |
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. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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