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PREDICTORS OF EXCESSIVE BLEEDING DESPITE ANTIFIBRINOLYTICS IN CARDIAC SURGERY

Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

INTRODUCTION

Antifibrinolytics are being used routinely to control excessive bleeding after cardiac surgery. However, postoperative excessive bleeding persists despite pharmaceutical management. In this retrospective study we sought to define perioperative predictors for excessive bleeding in cardiac surgery despite pharmacological intervention.

METHODS

After institutional ethics committee approval, we reviewed 2350 patients who underwent cardiac surgery from Nov.1999 - Oct. 2000. There were 78.6% CABG, 21.5% valve surgery and 3.9% aortic root surgery. One hundred eighty six patients of 2230 patients (8.3%) had previous cardiac surgery. All patients routinely received tranexamic acid (TA) 50-100 mg/kg prior to cardiopulmonary bypass (CPB). Excessive bleeding was defined as bleeding over 750 ml through chest drains over 6 hours postoperatively. Statistical analysis was performed using multivariant and logistic regression tests with a significance level of p<0.05.

RESULTS

Ninety three of 2013 patients (4.6%) undergoing cardiac surgery had excessive bleeding. Forty of 93 excessively bleeding patients (43%) required re-exploration. Length of cardiopulmonary bypass (P=0.0001), aortic surgery (P=0.012), preoperative creatinine level (P=0.034), previous cardiac surgery (P=0.043), and insertion of Intra Aortic Balloon Pump (P=0.04) were independent predictors of excessive postoperative bleeding.

Age, preoperative medication (coumadin, aspirin or heparin) emergency surgery and acute endocarditis were not predictive of excessive postoperative bleeding in our population. The incidence of blood transfusion in the excessive bleeding group was 86% compared to 43% in the non -excessive bleeding group (P=0.0001).

CONCLUSION

Use of antifibrinolytic, tranexamic acid, before cardiac surgery cannot completely eliminate excessively bleeding patients. The most important risk factor of excessive bleeding in patients undergoing cardiac surgery was prolonged duration of CPB.

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