Email updates

Keep up to date with the latest news and content from Journal of Cardiothoracic Surgery and BioMed Central.

Open Access Research article

Preoperative thrombin generation is predictive for the risk of blood loss after cardiac surgery: a research article

Yvonne Bosch1*, Raed Al Dieri2, Hugo ten Cate3, Patty Nelemans4, Saartje Bloemen2, Coenraad Hemker2, Patrick Weerwind1, Jos Maessen1 and Baheramsjah Mochtar1

Author Affiliations

1 Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, P. Debeyelaan 25, PO Box 5800, 6202, AZ, Maastricht, the Netherlands

2 Synapse BV, Maastricht University Medical Center, PO Box 616, 6200, MD, Maastricht, the Netherlands

3 Department of Internal Medicine, Maastricht University Medical Center, P. Debeyelaan 25, PO Box 5800, 6202, AZ, Maastricht, the Netherlands

4 Department of Epidemiology, Maastricht University Medical Center, PO Box 616, 6200, MD, Maastricht, the Netherlands

For all author emails, please log on.

Journal of Cardiothoracic Surgery 2013, 8:154  doi:10.1186/1749-8090-8-154

Published: 12 June 2013

Abstract

Background

In this study the value of thrombin generation parameters measured by the Calibrated Automated Thrombography for prediction of blood loss after cardiac surgery with cardiopulmonary bypass was investigated.

Methods

Thirty male patients undergoing first-time coronary artery bypass grafting were enrolled. Blood samples were taken pre-bypass before heparinisation (T1) and 5 min after protamine administration (T2). Thrombin generation was measured both in platelet-rich plasma and in platelet-poor plasma. Besides thrombin generation measurements, activated clotting time, haematocrit, haemoglobin, platelet number, fibrinogen, antithrombin, D-dimers, prothrombin time and activated partial thromboplastin time were determined. Blood loss was measured and the amount of transfusion products was recorded postoperatively until 20 hours after surgery. Patients were divided into two groups based on the median volume of postoperative blood loss (group 1: patients with median blood loss <930 ml; group 2: patients with median blood loss ≥930 ml).

Results

On T1, patients of group 2 had a significantly lower endogenous thrombin potential and peak thrombin (p<0.001 and p=0.004 respectively) in platelet-rich plasma, a significantly lower endogenous thrombin potential (p=0.004) and peak thrombin (p=0.014) in platelet-poor plasma, and a lower platelet count (p=0.002). On T2 both endogenous thrombin potential and peak thrombin remain significantly lower (p=0.011 and p=0.010) in group 2, measured in platelet-rich plasma but not in platelet-poor plasma. In addition, platelet number remains lower in group 2 after protamine administration (p=0.002).

Conclusions

The key finding is that the Calibrated Automated Thrombography assay, performed preoperatively, provides information predictive for blood loss after cardiac surgery.

Keywords:
Bleeding; Blood (anti)coagulation; Blood loss; Thrombin generation; CABG; CPB