Contributions
Abstract: P07
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Cardiopulmonary bypass (CPB) is associated with complex activation of hemostatic system. The complexity of this patterns cannot be described by standard laboratory tests especially during full heparinization. Thrombelastography (TEG) is reliable method for detection of hemostatic abnormalities during surgery. Some limitation of this examination are necessity to know platelet count and function, concentration of fibrinogen, threshold level of ionised calcium and temperature adjustment.
Two groups of elective cardiac surgery patients were evaluated in prospective randomized study. Group TEG (n=499) was monitored both with TEG and laboratory tests (prothrombin time - PT, thrombin time, - TT, activated partial thromboplastin time-aPTT, fibrinogen - FBG, platelet count and function, fibrin degradation products- FDP). Standard ACT (Activated Clotting Time – Hemochron® - kaolin activated) monitoring was provided. Group Control (n=475) was monitored only with laboratory tests. Thrombelastograph TEG®5000 Series (Haemoscope, Niles, IL, USA) was used. Blood was sampled from central venous cathether without heparin flush. Kaolin activated cuvettes were used.The following TEG measurements were performed: 1st after induction of anesthesia (native), 2nd during cardiopulmonary bypass (CPB) after X-clamp releasing (heparinase), 3rd and 4th 10min after protamine administrativ (nativ and heparinase). Hemostatic profile with using TEG algorithm (delivered by manufacturer), changes of TEG parameters and laboratory tests before and after CPB, blood loss, number of transfusion and reexploration because of bleeding were evaluated. Standard dosing of heparin (3mg/kg bolus+1mg/kg to CPB) and no profylactic antifibrinolytics were used. Chronic antiplatelet/anticoagulation drugs were withdrawn according to ESC/ESA guidelines.
Results
Both groups were comparable by demographics (TEG/Control):. Mean age 67,5 vs 68,4. Type of surgery % (CABG 65/73, valvular 17/12, combined 15/13, other 2/1). No difference in CPB parameters (CPB time 80/78 min, total heparin 310/311 mg and protamin 339/339 mg dose). No significant difference in peroperative blood loss (373±351/351±229 ml), number of transfusion (RBC 0,63/0,70 RBC unit/pt, 0,34/0,40 FFP unit/pt, 0,01/0,01 platelet unit/pt), therapeutic antifibrinolytics administration (12/10,7%) and reexploration because of bleeding (1,6%/2,5%) were recorded. The only significant difference in postoperative blood loss (819±519 vs 861±422 ml, p<0,05) was assessed.
Values of PT, aPTT, TT significantly increased, fibrinogen and platelets significantly decreased during CPB (212±64 vs 134±44 in TEG, 218±65 vs 139±46 in control). Changes of PT, aPTT and platelets correlated with CPB duration. The main hemostatic patterns according to TEG algorithm: T1: 18,0% platelet hyperfunction, 12,4% enzymatic hypercoagulability. T2: 22,8% platelet hypofunction, 19% primary fibrinolysis. T3: 9,4% platelet hypofunction, 7% primary fibrinolysis. T4: 15,0% platelet hypofunction, 8% enzymatic hypercoagulation.
Conclusion
Platelet decrease is usual during CPB. Platelet hypofunction and primary fibrinolysis were the most common patterns during CPB. We need a new technique to preserve platelets during CPB. One option is using of autologous platelet-rich plasma apheresis before CPB and monitoring their function by aggregation methods.
Acknowledgement
Supported by MH CZ – DRO (FNOl, 00098892) and LF 2016-001
Abstract: P07
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Cardiopulmonary bypass (CPB) is associated with complex activation of hemostatic system. The complexity of this patterns cannot be described by standard laboratory tests especially during full heparinization. Thrombelastography (TEG) is reliable method for detection of hemostatic abnormalities during surgery. Some limitation of this examination are necessity to know platelet count and function, concentration of fibrinogen, threshold level of ionised calcium and temperature adjustment.
Two groups of elective cardiac surgery patients were evaluated in prospective randomized study. Group TEG (n=499) was monitored both with TEG and laboratory tests (prothrombin time - PT, thrombin time, - TT, activated partial thromboplastin time-aPTT, fibrinogen - FBG, platelet count and function, fibrin degradation products- FDP). Standard ACT (Activated Clotting Time – Hemochron® - kaolin activated) monitoring was provided. Group Control (n=475) was monitored only with laboratory tests. Thrombelastograph TEG®5000 Series (Haemoscope, Niles, IL, USA) was used. Blood was sampled from central venous cathether without heparin flush. Kaolin activated cuvettes were used.The following TEG measurements were performed: 1st after induction of anesthesia (native), 2nd during cardiopulmonary bypass (CPB) after X-clamp releasing (heparinase), 3rd and 4th 10min after protamine administrativ (nativ and heparinase). Hemostatic profile with using TEG algorithm (delivered by manufacturer), changes of TEG parameters and laboratory tests before and after CPB, blood loss, number of transfusion and reexploration because of bleeding were evaluated. Standard dosing of heparin (3mg/kg bolus+1mg/kg to CPB) and no profylactic antifibrinolytics were used. Chronic antiplatelet/anticoagulation drugs were withdrawn according to ESC/ESA guidelines.
Results
Both groups were comparable by demographics (TEG/Control):. Mean age 67,5 vs 68,4. Type of surgery % (CABG 65/73, valvular 17/12, combined 15/13, other 2/1). No difference in CPB parameters (CPB time 80/78 min, total heparin 310/311 mg and protamin 339/339 mg dose). No significant difference in peroperative blood loss (373±351/351±229 ml), number of transfusion (RBC 0,63/0,70 RBC unit/pt, 0,34/0,40 FFP unit/pt, 0,01/0,01 platelet unit/pt), therapeutic antifibrinolytics administration (12/10,7%) and reexploration because of bleeding (1,6%/2,5%) were recorded. The only significant difference in postoperative blood loss (819±519 vs 861±422 ml, p<0,05) was assessed.
Values of PT, aPTT, TT significantly increased, fibrinogen and platelets significantly decreased during CPB (212±64 vs 134±44 in TEG, 218±65 vs 139±46 in control). Changes of PT, aPTT and platelets correlated with CPB duration. The main hemostatic patterns according to TEG algorithm: T1: 18,0% platelet hyperfunction, 12,4% enzymatic hypercoagulability. T2: 22,8% platelet hypofunction, 19% primary fibrinolysis. T3: 9,4% platelet hypofunction, 7% primary fibrinolysis. T4: 15,0% platelet hypofunction, 8% enzymatic hypercoagulation.
Conclusion
Platelet decrease is usual during CPB. Platelet hypofunction and primary fibrinolysis were the most common patterns during CPB. We need a new technique to preserve platelets during CPB. One option is using of autologous platelet-rich plasma apheresis before CPB and monitoring their function by aggregation methods.
Acknowledgement
Supported by MH CZ – DRO (FNOl, 00098892) and LF 2016-001