Coagulopathy and hemostatic monitoring in cardiac surgery: An update

Scandinavian Cardiovascular Journal

Volumn 46, Issue 4, 2012, Pages 194-202

  Johansson, Pär I ^a,b   Sølbeck, Sacha ^a   Genet, Gustav ^a   Stensballe, Jakob ^a   Ostrowski, Sisse R ^a  

^a UNIVERSITY OF COPENHAGEN   (Denmark)

^b UNIVERSITY OF TEXAS MEDICAL SCHOOL   (United States)

Author keywords

Cardiac surgery; Coagulopathy; Haemostasis

Indexed keywords

ACETYLSALICYLIC ACID; AMINOCAPROIC ACID; ANTITHROMBOCYTIC AGENT; ANTIVITAMIN K; APIXABAN; CLOPIDOGREL; DABIGATRAN; EPTIFIBATIDE; HEPARIN; NONSTEROID ANTIINFLAMMATORY AGENT; PRASUGREL; PROTAMINE SULFATE; RIVAROXABAN; TRANEXAMIC ACID; WARFARIN;

ACIDOSIS; ANTICOAGULATION; BLEEDING; BLOOD CLOTTING DISORDER; BLOOD CLOTTING TEST; BLOOD EXAMINATION; BLOOD TRANSFUSION; CARDIOPULMONARY BYPASS; DILUTIONAL COAGULOPATHY; DISSEMINATED INTRAVASCULAR CLOTTING; HEART SURGERY; HEMOSTASIS; HUMAN; HYPERFIBRINOLYSIS; HYPOTHERMIA; INTERMETHOD COMPARISON; PARTIAL THROMBOPLASTIN TIME; POSTOPERATIVE COMPLICATION; POSTOPERATIVE HEMORRHAGE; POSTOPERATIVE THROMBOSIS; PRIORITY JOURNAL; PROTHROMBIN TIME; REOPERATION; REVIEW; THROMBOCYTE AGGREGATION; THROMBOCYTE AGGREGATION INHIBITION; THROMBOELASTOGRAPHY; VISCOELASTIC HEMOSTATIC ASSAY;

ACIDOSIS; ANTICOAGULANTS; BLOOD COAGULATION; BLOOD COAGULATION TESTS; CARDIAC SURGICAL PROCEDURES; HEMOSTASIS; HEMOSTATIC TECHNIQUES; HUMANS; HYPOTHERMIA, INDUCED; MONITORING, PHYSIOLOGIC; RISK;

EID: 84863791831     PISSN: 14017431     EISSN: 16512006     Source Type: Journal    
DOI: 10.3109/14017431.2012.671487     Document Type: Review

References (94)

1. Despotis GJ, Avidan MS, Hogue CW, Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg. 2001;72:S1821-31.
2. Shander A, Rijhwani TS. Clinical outcomes in cardiac surgery: Conventional surgery versus bloodless surgery. Anesthesiol Clin North America. 2005;23:327-45.
3. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. First of two parts-blood transfusion. N Engl J Med. 1999;340:438-47.
4. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. Second of two parts-blood conservation. N Engl J Med. 1999;340:525-33.
5. Whitson BA, Huddleston SJ, Savik K, Shumway SJ. Bloodless cardiac surgery is associated with decreased morbidity and mortality. J Card Surg. 2007;22:373-8.
6. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fl uid management. Anesthesiology. 2008;109:723-40.
7. Knotzer H, Pajk W, Maier S, Dunser MW, Ulmer H, Schwarz B, et al. Comparison of lactated Ringer's, gelatine and blood resuscitation on intestinal oxygen supply and mucosal tissue oxygen tension in haemorrhagic shock. Br J Anaesth. 2006;97:509-16.
8. Jacob M, Chappell D, Rehm M. The third spacé-fact or fi ction? Best Pract Res Clin Anaesthesiol. 2009;23:145-7.
9. Appelman MH, van Barneveld LJ, Romijn JW, Vonk AB, Boer C. The impact of balanced hydroxylethyl starch cardiopulmonary bypass priming solution on the fi brin part of clot formation: Ex vivo rotation thromboelastometry. Perfusion. 2011;26:175-80.
10. Mortier E, Ongenae M, De Baerdemaeker L, Herregods L, Den Blauwen N, Van Aken J, et al. In vitro evaluation of the effect of profound haemodilution with hydroxyethyl starch 6%, modifi ed fl uid gelatin 4% and dextran 40 10% on coagulation profi le measured by thromboelastography. Anaesthesia. 1997;52:1061-4.
11. Nielsen VG. Colloids decrease clot propagation and strength: Role of factor XIII-fi brin polymer and thrombin-fi brinogen interactions. Acta Anaesthesiol Scand. 2005;49:1163-71.
12. Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, et al. Hemostatic changes after crystalloid or colloid fl uid administration during major orthopedic surgery: The role of fi brinogen administration. Anesth Analg. 2007;105:905-17.
13. Emmert MY, Salzberg SP, Theusinger OM, Felix C, Plass A, Hoerstrup SP, et al. How good patient blood management leads to excellent outcomes in Jehovah's witness patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg. 2011;12:183-8.
14. Hess JR. Massive transfusion for trauma: opportunities and risks. ISBT Science Series. 2008;3:197-201.
15. Di EM, Wesselink RM, Morshuis WJ, Dossche KM, Schepens MA. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: A retrospective comparative study. J Thorac Cardiovasc Surg. 2003;125:849-54.
16. Pacini D, Di ML, Leone A, Di BR, Sodeck G, Englberger L, et al: Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: Clinical outcomes in elderly patients. Eur J Cardiothorac Surg. 2012.
17. Wolberg AS, Meng ZH, Monroe DM, III, Hoffman M. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma. 2004;56:1221-8.
18. Yoshihara H, Yamamoto T, Mihara H. Changes in coagulation and fi brinolysis occurring in dogs during hypothermia. Thromb Res. 1985;37:503-12.
19. Romlin B, Petruson K, Nilsson K. Moderate superfi cial hypothermia prolongs bleeding time in humans. Acta Anaesthesiol Scand. 2007;51:198-201.
20. Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: A review of mechanisms. J Trauma. 2008;65:748-54.
21. Djaldetti M, Fishman P, Bessler H, Chaimoff C. pH-induced platelet ultrastructural alterations. A possible mechanism for impaired platelet aggregation. Arch Surg. 1979;114: 707-10.
22. Martini WZ, Holcomb JB. Acidosis and coagulopathy: The differential effects on fi brinogen synthesis and breakdown in pigs. Ann Surg. 2007;246:831-5.
23. Sniecinski RM, Chandler WL. Review articles: Activation of the hemostatic system during cardiopulmonary bypass. Anesth Analg. 2011;113:1319-33.
24. Coakley M, Hall JE, Evans C, Duff E, Billing V, Yang L, et a l. Assessment of thrombin generation measured before and after cardiopulmonary bypass surgery and its association with postoperative bleeding. J Thromb Haemost. 2011;9:282-92.
25. Casonato A, Sponga S, Pontara E, Cattini MG, Basso C, Thiene G, et al. von Willebrand factor abnormalities in aortic valve stenosis: Pathophysiology and impact on bleeding. Thromb Haemost. 2011;106:58-66.
26. Geisen U, Heilmann C, Beyersdorf F, Benk C, Berchtold- Herz M, Schlensak C, et al. Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease. Eur J Cardiothorac Surg. 2008;33: 679-84.
27. Heilmann C, Geisen U, Beyersdorf F, Nakamura L, Benk C, Berchtold-Herz M, et al. Acquired von Willebrand syndrome in patients with ventricular assist device or total artifi cial heart. Thromb Haemost. 2010;103:962-7.
28. Jamieson WR, Dryden PJ, O'Connor JP, Sadeghi H, Ansley DM, Merrick PM, et al. Benefi cial effect of both tranexamic acid and aprotinin on blood loss reduction in reoperative valve replacement surgery. Circulation. 1997;96: II-96-100.
29. Lowenstein CJ, Morrell CN, Yamakuchi M. Regulation of Weibel-Palade body exocytosis. Trends Cardiovasc Med. 2005;15:302-8.
30. Knipe L, Meli A, Hewlett L, Bierings R, Dempster J, Skehel P, et al. A revised model for the secretion of tPA and cytokines from cultured endothelial cells. Blood. 2010;116:2183-91.
31. Rijken DC, Lijnen HR. New insights into the molecular mechanisms of the fi brinolytic system. J Thromb Haemost. 2009;7:4-13.
32. Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, et al. Anti-fi brinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011;3:CD001886.
33. Koster A, Fischer T, Praus M, Haberzettl H, Kuebler WM, Hetzer R, et al. Hemostatic activation and infl ammatory response during cardiopulmonary bypass: Impact of heparin management. Anesthesiology. 2002;97:837-41.
34. Koster A, Despotis G, Gruendel M, Fischer T, Praus M, Kuppe H, et al. The plasma supplemented modifi ed activated clotting time for monitoring of heparinization during cardiopulmonary bypass: A pilot investigation. Anesth Analg. 2002;95:26-30.
35. Cannon WB. The Adrenal Medulla. Bull N Y Acad Med. 1940;16:3-13.
36. Nielsen VG, Malayaman SN. Protamine sulfate: Crouching clot or hidden hemorrhage? Anesth Analg. 2010;111:593-4.
37. Bolliger D, Szlam F, Azran M, Koyama K, Levy JH, Molinaro RJ, et al. The anticoagulant effect of protamine sulfate is attenuated in the presence of platelets or elevated factor VIII concentrations. Anesth Analg. 2010;111:601-8.
38. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002-12.
39. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: A prevalent adverse effect resulting in regulatory action. Arch Intern Med. 2007;167:1414-19.
40. Oldgren J, Alings M, Darius H, Diener HC, Eikelboom J, Ezekowitz MD, et al. Risks for stroke, bleeding, and death in patients with atrial fi brillation receiving dabigatran or warfarin in relation to the CHADS2 score: A subgroup analysis of the RE-LY trial. Ann Intern Med. 2011;155:660-7, W204.
41. Huang J, Cao Y, Liao C, Wu L, Gao F. Apixaban versus enoxaparin in patients with total knee arthroplasty. A metaanalysis of randomised trials. Thromb Haemost. 2011;105:245-53.
42. D uggan ST. Rivaroxaban. a review of its use for the prophylaxis of venous thromboembolism after total hip or knee replacement surgery. Am J Cardiovasc Drugs. 2012;12:57-72.
43. Levi M, Eerenberg ES, Kampuisen PW. Anticoagulants. Old and new. Hamostaseologie. 2011;31:229-35.
44. Cotton BA, McCarthy JJ, Holcomb JB. Acutely injured patients on dabigatran. N Engl J Med. 2011;365:2039-40.
45. Bhatt DL, Topol EJ. Scientifi c and therapeutic advances in antiplatelet therapy. Nat Rev Drug Discov. 2003;2:15-28.
46. Jacob M, Smedira N, Blackstone E, Williams S, Cho L. Effect of timing of chronic preoperative aspirin discontinuation on morbidity and mortality in patients having combined coronary artery bypass grafting and valve surgery. Am J Cardiol. 2012;109:824-30.
47. Jacob M, Smedira N, Blackstone E, Williams S, Cho L. Effect of timing of chronic preoperative aspirin discontinuation on morbidity and mortality in coronary artery bypass surgery. Circulation. 2011;123:577-83.
48. Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg. 2004;78:1536-41.
49. Herman CR, Buth KJ, Kent BA, Hirsch GM. Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. Ann Thorac Surg. 2010;89:397-402.
50. Alexopoulos D, Xanthopoulou I, Davlouros P, Plakomyti TE, Panagiotou A, Mavronasiou E, et al. Prasugrel overcomes high on-clopidogrel platelet reactivity in chronic coronary artery disease patients more effectively than high dose (150 mg) clopidogrel. Am Heart J. 2011;162:733-9.
51. Spinler SA, Rees C. Review of prasugrel for the secondary prevention of atherothrombosis. J Manag Care Pharm. 2009;15:383-95.
52. Alexopoulos D. Prasugrel resistance: Fact or fi ction. Platelets. 2012;23:83-90.
53. Roberts HR, Hoffman M, Monroe DM. A cell-based model of thrombin generation. Semin Thromb Hemost. 2006;32:32-8.
54. Fries D, Innerhofer P, Schobersberger W. Time for changing coagulation management in trauma-related massive bleeding. Curr Opin Anaesthesiol. 2009;22:267-74.
55. Murray D, Pennell B, Olson J. Variability of prothrombin time and activated partial thromboplastin time in the diagnosis of increased surgical bleeding. Transfusion. 1999;39: 56-62.
56. Segal JB, Dzik WH. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: An evidence-based review. Transfusion. 2005;45:1413-25.
57. Hartert H. Blutgerinnungsstudien mit der thrombelastographie, einem neuen untersuchungsverfahren. Klin Wochenschr. 1948;26:577-83.
58. Johansson PI, Stissing T, Bochsen L, Ostrowski SR. Thrombelastography and tromboelastometry in assessing coagulopathy in trauma. Scand J Trauma Resusc Emerg Med. 2009;17:45.
59. Johansson PI, Bochsen L, Andersen S, Viuff D. Investigation of the effect of kaolin and tissue factor-activated citrated whole blood, on clot forming variables, as evaluated by thromboelastography. Transfusion. 2008;48:2377-83.
60. Monroe DM, Hoffman M. What does it take to make the perfect clot? Arterioscler Thromb Vasc Biol. 2006;26:41-8.
61. Kawasaki J, Katori N, Kodaka M, Miyao H, Tanaka KA. Electron microscopic evaluations of clot morphology during thrombelastography. Anesth Analg. 2004;99:1440-4.
62. Johansson PI, Svendsen MS, Salado J, Bochsen L, Kristensen AT. Investigation of the thrombin-generating capacity, evaluated by thrombogram, and clot formation evaluated by thrombelastography of platelets stored in the blood bank for up to 7 days. Vox Sang. 2008;94:113-18.
63. Rivard GE, Brummel-Ziedins KE, Mann KG, Fan L, Hofer A, Cohen E, et al. Evaluation of the profi le of thrombin generation during the process of whole blood clotting as assessed by thrombelastography. J Thromb Haemost. 2005;3: 2039-43.
64. Chakroun T, Gerotziafas GT, Seghatchian J, Samama MM, Hatmi M, Elalamy I, et al. The infl uence of fi brin polymerization and platelet-mediated contractile forces on citrated whole blood thromboelastography profi le. Thromb Haemost. 2006;95:822-8.
65. Nielsen VG, Cohen BM, Cohen E. Elastic modulus-based thrombelastographic quantifi cation of plasma clot fi brinolysis with progressive plasminogen activation. Blood Coagul Fibrinolysis. 2006;17:75-81.
66. Ganter MT, Hofer CK. Coagulation monitoring: Current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg. 2008;106:1366-75.
67. Tuman KJ, Spiess BD, McCarthy RJ, Ivankovich AD. Effects of progressive blood loss on coagulation as measured by thrombelastography. Anesth Analg. 1987 66:856-63.
68. Spiess BD, Tuman KJ, McCarthy RJ, DeLaria GA, Schillo R, Ivankovich AD, et al. Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies. J Clin Monit. 1987;3:25-30.
69. Tuman KJ, Spiess BD, McCarthy RJ, Ivankovich AD. Comparison of viscoelastic measures of coagulation after cardiopulmonary bypass. Anesth Analg. 1989;69:69-75.
70. Essell JH, Martin TJ, Salinas J, Thompson JM, Smith VC. Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 1993;7:410-15.
71. Tuman KJ, McCarthy RJ, Djuric M, Rizzo V, Ivankovich AD. Evaluation of coagulation during cardiopulmonary bypass with a heparinase-modifi ed thromboelastographic assay. J Cardiothorac Vasc Anesth. 1994;8:144-9.
72. S piess BD, Gillies BS, Chandler W, Verrier E. Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients. J Cardiothorac Vasc Anesth. 1995;9:168-73.
73. Shih RL, Cherng YG, Chao A, Chen JT, Tsai AL, Liu CC, et al. Prediction of bleeding diathesis in patients undergoing cardiopulmonary bypass during cardiac surgery: viscoelastic measures versus routine coagulation test. Acta Anaesthesiol Sin. 1997;35:133-9.
74. Cherng YG, Chao A, Shih RL, Lin CS, Chan WH, Huang CH, et al. Preoperative evaluation and postoperative prediction of hemostatic function with thromboelastography in patients undergoing redo cardiac surgery. Acta Anaesthesiol Sin. 1998;36:179-86.
75. Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA, et al. Thromboelastographyguided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg. 1999;88:312-19.
76. Royston D, von Kier S. Reduced haemostatic factor transfusion using heparinase-modifi ed thrombelastography during cardiopulmonary bypass. Br J Anaesth. 2001;86:575-8.
77. Manikappa S, Mehta Y, Juneja R, Trehan N. Changes in transfusion therapy guided by thromboelastograph in cardiac surgery. Ann Card Anaesth. 2001;4:21-7.
78. Welsby IJ, Jiao K, Ortel TL, Brudney CS, Roche AM, Bennett-Guerrero E, et al. The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery. J Cardiothorac Vasc Anesth. 2006;20:531-5.
79. Anderson L, Quasim I, Soutar R, Steven M, Macfi e A, Korte W, et al. An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit. Transfus Med. 2006;16:31-9.
80. Westbrook AJ, Olsen J, Bailey M, Bates J, Scully M, Salamonsen RF, et al. Protocol based on Thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: A pilot study. Heart Lung Circ. 2009; 18:277-88.
81. Reinhofer M, Brauer M, Franke U, Barz D, Marx G, Losche W, et al. The value of rotation thromboelastometry to monitor disturbed perioperative haemostasis and bleeding risk in patients with cardiopulmonary bypass. Blood Coagul Fibrinolysis. 2008;19:212-19. Ak K,
82. Isbir CS, Tetik S, Atalan N, Tekeli A, Aljodi M, et a l. Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: A prospective randomized study. J Card Surg. 2009;24:404-10.
83. Afshari A, Wikkelso A, Brok J, Moller AM, Wetterslev J. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev. 2011;3:CD007871.
84. Douning LK, Ramsay MA, Swygert TH, Hicks KN, Hein HA, Gunning TC, et al. Temperature corrected thrombelastography in hypothermic patients. Anesth Analg. 1995;81:608-11.
85. Kettner SC, Sitzwohl C, Zimpfer M, Kozek SA, Holzer A, Spiss CK, et al. The effect of graded hypothermia (36 degrees C-32 degrees C) on hemostasis in anesthetized patients without surgical trauma. Anesth Analg. 2003;96:1772-6.
86. Bowbrick VA, Mikhailidis DP, Stansby G. Value of thromboelastography in the assessment of platelet function. Clin Appl Thromb Hemost. 2003;9:137-42.
87. Tanaka KA, Szlam F, Kelly AB, Vega JD, Levy JH. Clopidogrel (Plavix) and cardiac surgical patients: Implications for platelet function monitoring and postoperative bleeding. Platelets. 2004;15:325-32.
88. Katori N, Szlam F, Levy JH, Tanaka KA. A novel method to assess platelet inhibition by eptifi batide with thrombelastograph. Anesth Analg. 2004;99:1794-9.
89. Johansson PI. Treatment of massively bleeding patients: Introducing real-time monitoring, transfusion packages and thrombelastography (TEGR). ISBT Science Series. 2007;2:159-67.
90. Hayward CP, Moffat KA, Raby A, Israels S, Plumhoff E, Flynn G, et al. Development of North American consensus guidelines for medical laboratories that perform and interpret platelet function testing using light transmission aggregometry. Am J Clin Pathol. 2010;134:955-63.
91. Ferreiro JL, Sibbing D, Angiolillo DJ. Platelet function testing and risk of bleeding complications. Thromb Haemost. 2010;103:1128-35.
92. Collyer TC, Gray DJ, Sandhu R, Berridge J, Lyons G. Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography Platelet Mapping. Br J Anaesth. 2009;102:492-8.
93. Topf HG, Weiss D, Lischetzki G, Strasser E, Rascher W, Rauh M. Evaluation of a modifi ed thromboelastography assay for the screening of von Willebrand disease. Thromb Haemost. 2011;105:1091-9.
94. Valarche V, Desconclois C, Boutekedjiret T, Dreyfus M, Proulle V. Multiplate whole blood impedance aggregometry: A new tool for von Willebrand disease. J Thromb Haemost. 2011;9:1645-7.