DOI: 10.1097/01.sa.0000267096.78237.2f
,
Issn Print: 0039-6206
Publication Date: 2007/10/01
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Excerpt
Gregory A. Nuttall, Nicole Henderson, Michael Quinn, Clay Blair, Layne Summers, Brent A. Williams, William C. Oliver, and Paula J. Santrach
(Anesth Analg, 102:1012-1017, 2006)
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Surgical patients with major known genetic deficiencies in coagulation are at risk for excessive bleeding, but this complication occurs as well when such genetic defects are not present. Certain subpopulations of patients may have genetic polymorphisms that only become expressed during surgery involving substantial blood loss, such as cardiac surgery with cardiopulmonary bypass (CPB). A retrospective chart review examined the hypothesis that excessive bleeding during a first cardiac operation increases the risk for excessive bleeding in a subsequent surgery.
Included in the review were adult patients who had undergone 2 cardiac surgeries with CPB during the period between January 19, 1990, and June 25, 2002. Excessive bleeding was defined as a postoperative chest tube drainage (CTD) over 24 hours of ≥750 mL and a transfusion of any non-red blood cell (RBC) products. Separate analyses were conducted for each of these variables. Factors associated with excessive bleeding were included as adjustors in the multivariable analysis.
Patients were 119 men and 55 women whose median age were 63 years at the time of the first operation and 67 years at the second surgery. None had a documented history of conditions affecting coagulation or were exposed to glycoprotein IIb/IIIa receptor antagonists or clopidogrel before surgery. For the first operation, the median CTD for the first 24 hours was 670 mL; 25% of the patients received at least 1 non-RBC blood product. For the second procedure, the median CTD for the first 24 hours was 492 mL; 41% of patients received 1 or more non-RBC blood products. Excessive bleeding during the first surgery was associated with a more than 2 times increased risk for excessive bleeding in the second surgery. This risk was noted after adjustment for age, sex, body surface area, preoperative anticoagulant use, CPB duration, and procedure type at the second surgery. Some patients may have an inherent subclinical disorder that becomes active in response to changes associated with cardiac surgery requiring CPB.
