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PREDICTORS FOR EXCESSIVE BLEEDING AND TRANSFUSION IN HEART TRANSPLANTS

^* Department of Anesthesia
^® and Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

INTRODUCTION

Excessive postoperative bleeding and blood transfusion are major complications in heart transplant (HT) patients despite the use of antifibrinolytics. This study sought predictors for bleeding and blood transfusion in patients undergoing heart transplantation with antifibrinolytics.

METHODS

After IRB approval, we retrospectively reviewed charts of 179 consecutive HT patients from 1990 to 1999 years. Tranexamic acid 8.7±3.6 grams were given to 156 patients and epsilon-aminocaproic acid 12±5 grams to 6 patients. Predictors for excessive bleeding and blood product utilization were analyzed by multivariant analysis. Mean values and SD are presented.

RESULTS

Data are presented n=179; age 49 ± 11, weight 71 kg ± 15, preop hemoglobin (Hgb) 120 g/L ± 22, creatinine 151 mmol/L ± 62, prothrombin time (PT) 19.5 sec ± 9, Cardiopulmonary bypass (CBP) 132 min ± 50, lowest temperature on CPB 33.3°C ± 2.5, blood loss at 6 and 12 hours postop 521 ± 707 and 956 ± 1293 respectively.

Postoperatively 20% of patients bled excessively > 750 ml in 6 hr. 70% of these patients had previous cardiac surgery (p = 0.003). 48% of excessive bleeding patients had chest re-exploration to control bleeding. Their average blood loss in 6 hours post operatively was 1500 ±1178 ml as compared to 294±162 ml of those non-excessive bleeding patients (p = 0.0001). Previous cardiac surgery and CPB duration were the only independent predictors for excessive postoperative bleeding (P = 0.002 and 0.0001 respectively). Age, preop creatinine and PT levels were not predictive of excessive bleeding.

Red blood cells (RBC) were given to 38% of patients in OR. Preop Hgb., CPB duration, preop creatinine and previous heart surgery but not age or PT were predictive for blood transfusion in the OR. (P = 0.0001, p = 0.002, p = 0.02, p = 0.05). Postop 88% of all patients received RBC transfusion. Preop Hgb and excessive bleeding were predictive for the need for blood transfusion in the postop period (p = 0.003 and p = 0.02). Age, preop creatinine and PT were not predictive.

Independent predictors for excessive bleeding are CPB duration and previous sternotomy. Predictors for RBC transfusion intra-op are pre-op Hgb., creatinine levels, previous sternotomy, CPB duration and post-op are pre-op Hgb. and excessive bleeding respectively.

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