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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...

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Autores principales: 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
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
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.
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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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