title: Hemorrhage related reexploration following open heart surgery: the impact of pre-operative and post-operative coagulation testing.
abstract: OBJECTIVE
  Our objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery.
  
  
  METHODS
  Retrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures.
  
  
  RESULTS
  Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients (P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients (P<0.05).
  
  
  CONCLUSIONS
  Pre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.
authors.affiliation: Department of Cardiothoracic Surgery, University of California, PO Box 0118, M593, San Francisco, CA 94143, USA. tshall@itsa.ucsf.edu
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Hall
authors.forename: Jean C
authors.initials: JC
authors.lastname: Sines
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Spotnitz
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D001780:Blood Coagulation Tests / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors