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Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study
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 associ...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2007
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1950484/ https://www.ncbi.nlm.nih.gov/pubmed/17425777 http://dx.doi.org/10.1186/1749-8090-2-17 |
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author | Jimenez Rivera, Juan J 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 |
author_facet | Jimenez Rivera, Juan J 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 |
author_sort | Jimenez Rivera, Juan J |
collection | PubMed |
description | 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/m(2), (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. |
format | Text |
id | pubmed-1950484 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2007 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-19504842007-08-22 Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study Jimenez Rivera, Juan J 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 J Cardiothorac Surg Research Article 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/m(2), (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. BioMed Central 2007-04-10 /pmc/articles/PMC1950484/ /pubmed/17425777 http://dx.doi.org/10.1186/1749-8090-2-17 Text en Copyright © 2007 Rivera et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Jimenez Rivera, Juan J 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 Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
title | Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
title_full | Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
title_fullStr | Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
title_full_unstemmed | Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
title_short | Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
title_sort | factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1950484/ https://www.ncbi.nlm.nih.gov/pubmed/17425777 http://dx.doi.org/10.1186/1749-8090-2-17 |
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