Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients

TY - JOUR

T1 - Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients

AU - Rafiq, Sulman

AU - Johansson, Pär I

AU - Kofoed, Klaus F

AU - Olsen, Peter Skov

AU - Steinbrüchel, Daniel A

N1 - © 2016 Wiley Periodicals, Inc.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 170 patients were enrolled in this prospective observational study. TEG, Multiplate aggregometry, and coagulation tests were sampled on the day before surgery. Excessive bleeding was defined as >1000 mL over 18 hours. RESULTS: Multiplate-adenosine diphosphate (ADP) measurements were significantly lower in patients with excessive bleeding, 85.5AU ± 32.8 versus 108.5AU ± 30.0, p = 0.012. Bivariate analysis revealed body mass index, myocardial infarction, and multiplate-ADP as predictors of bleeding. In multivariable linear regression analysis, multiplate-ADP remained a significant predictor of bleeding (β: −6.2 [confidence interval: −12.0 to −0.3], p = 0.035). The lowest interval of multiplate-ADP (<50 AUC) was associated with significantly more bleeding and need for platelet concentrate transfusion. Fibrinogen levels <2.5 g/L were also found to be associated with excess bleeding (p = 0.020). CONCLUSIONS: Multiplate impedance aggregometry identified patients at risk for excessive bleeding after CABG. Low fibrinogen levels were associated with increased bleeding. Neither routine TEG parameters nor conventional coagulation tests were correlated with bleeding.

AB - BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 170 patients were enrolled in this prospective observational study. TEG, Multiplate aggregometry, and coagulation tests were sampled on the day before surgery. Excessive bleeding was defined as >1000 mL over 18 hours. RESULTS: Multiplate-adenosine diphosphate (ADP) measurements were significantly lower in patients with excessive bleeding, 85.5AU ± 32.8 versus 108.5AU ± 30.0, p = 0.012. Bivariate analysis revealed body mass index, myocardial infarction, and multiplate-ADP as predictors of bleeding. In multivariable linear regression analysis, multiplate-ADP remained a significant predictor of bleeding (β: −6.2 [confidence interval: −12.0 to −0.3], p = 0.035). The lowest interval of multiplate-ADP (<50 AUC) was associated with significantly more bleeding and need for platelet concentrate transfusion. Fibrinogen levels <2.5 g/L were also found to be associated with excess bleeding (p = 0.020). CONCLUSIONS: Multiplate impedance aggregometry identified patients at risk for excessive bleeding after CABG. Low fibrinogen levels were associated with increased bleeding. Neither routine TEG parameters nor conventional coagulation tests were correlated with bleeding.

KW - Aged

KW - Biomarkers

KW - Blood Coagulation Tests

KW - Coronary Artery Bypass

KW - Female

KW - Fibrinogen

KW - Hemorrhage

KW - Humans

KW - Male

KW - Middle Aged

KW - Platelet Aggregation

KW - Platelet Function Tests

KW - Postoperative Complications

KW - Predictive Value of Tests

KW - Preoperative Period

KW - Prospective Studies

KW - Risk

KW - Thrombelastography

KW - Journal Article

U2 - 10.1111/jocs.12807

DO - 10.1111/jocs.12807

M3 - Journal article

C2 - 27445266

SN - 0886-0440

VL - 31

SP - 565

EP - 571

JO - Journal of Cardiac Surgery

JF - Journal of Cardiac Surgery

IS - 9

ER -