Predictors of blood loss after coronary artery bypass grafting.
OBJECTIVE
To assess the predictive value of variables possibly associated with blood loss after coronary artery bypass grafting (CABG).


METHODS
A prospective study.


METHODS
A university hospital.


METHODS
Eighty-nine patients scheduled for elective CABG.


METHODS
Blood samples were drawn before and after surgery. Chest tube drainage was measured hourly until removal of drains.


RESULTS
Activation of coagulation and fibrinolysis, routine clotting tests, and expression of platelet surface antigens were analyzed using flow cytometry. A significant correlation was found among blood loss and activated partial thromboplastin time, fibrinogen, prothrombin fragment 1 + 2, D-dimers, platelet count, GPIb and P-selectin expression on platelets, use of internal thoracic artery, cross-clamp time, and thrombin-antithrombin III complex. In a multiple regression model, glycoprotein (GP) Ib expression on platelets, platelet count, use of internal thoracic artery, and D-dimers were significantly associated with blood loss. Logistic regression analysis showed that GPIb and D-dimers predicted an increased blood loss with a positive predictive value of 73% and a negative predictive value of 91%.


CONCLUSIONS
Postoperative D-dimers and GPIb expression may be useful to exclude nonsurgical causes in bleeding patients after CABG.
Wahba
A
A
Clinic of Cardiothoracic Surgery, University of Regensburg, Germany.
Rothe
G
G
Lodes
H
H
Barlage
S
S
Schmitz
G
G
Birnbaum
D E
DE
D000368:Aged; D001777:Blood Coagulation; D001792:Blood Platelets / Q000502:physiology; D001026:Coronary Artery Bypass; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D019038:Platelet Glycoprotein GPIb-IX Complex / Q000032:analysis; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D011446:Prospective Studies; D012044:Regression Analysis
D005338:Fibrin Fibrinogen Degradation Products; D019038:Platelet Glycoprotein GPIb-IX Complex; C036309:fibrin fragment D