title: Does coagulation differ between elderly and younger patients undergoing cardiac surgery?
abstract: OBJECTIVE
  Multiple improvements allow cardiac surgery in an increasingly older population. It is still unclear whether perioperative hemostasis differs between elderly and younger patients.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Single institutional study at an urban, university-affiliated hospital.
  
  
  METHODS
  Twenty-one consecutive patients aged over 80 years and 21 consecutive patients aged under 60 years undergoing first-time elective aortocoronary bypass grafting.
  
  
  METHODS
  None.
  
  
  RESULTS
  Modified thromboelastography (TEG) using different activators [intrinsic TEG (InTEG); extrinsic TEG (ExTEG); fibrinogen TEG (fibTEG)] was carried out to measure coagulation time [CT = reaction time (r)], clot formation time [CFT = coagulation time (k)], and maximum clot firmness [MCF = maximal amplitude (MA)]. Measurements were performed before surgery, at the end and 5 h after surgery on the intensive care unit (ICU), and on the morning of the 1st postoperative day (POD). Blood loss was slightly higher in the elderly than in the younger patients. Most TEG data were already significantly different between elderly and younger patients at baseline, indicating altered coagulation in the elderly prior to surgery (hypocoagulability). After surgery and on the ICU, elderly patients showed similar alterations in TEG to those of the younger patients (e.g. InTEG-CT: from 183+/-21 to 239+/-28 s versus from 146+/-15 to 186+/-26 s). On the 1st POD, most TEG data had returned almost to baseline values, however, they were still different between elderly and younger patients.
  
  
  CONCLUSIONS
  Elderly cardiac surgery patients already showed moderately altered coagulation prior to surgery. Thus elderly patients may be at risk of developing postoperative alterations in hemostasis on the ICU. The exact reasons for the impaired coagulation in the elderly remains to be determined.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany. BoldtJ@gmx.net
authors.forename: Joachim
authors.initials: J
authors.lastname: Boldt
authors.forename: Günther
authors.initials: G
authors.lastname: Haisch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kumle
authors.forename: Christian
authors.initials: C
authors.lastname: Brosch
authors.forename: Andreas
authors.initials: A
authors.lastname: Lehmann
authors.forename: Christiane
authors.initials: C
authors.lastname: Werling
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013223:Statistics as Topic; D013916:Thrombelastography