Correlation between thrombin potential and bleeding after cardiac surgery in adults.
We used a sensitive assay to measure thrombin potential in 20 patients who underwent cardiopulmonary bypass surgery for coronary artery bypass grafts. We measured coagulation factors II, V, VII, VIII and X. Blood loss was measured as the total amount in the mediastinal drains in the first 24 h postoperatively. Thrombin potential was median 107 nmol/l.min (range 62-181) preoperatively and median 46 nmol/l.min (range 19-120) postoperatively. Coagulation factors II, V, VII,VIII and X were within normal limits preoperatively. Factor II fell from 77 IU/dl preoperatively to 37 IU/dl at 120 min postoperatively. Factor V fell from 85 IU/dl preoperatively to 61 IU/dl postoperatively. Factor VII fell from 91 IU/dl to 66 IU/dl postoperatively. Factor VIII was 128 IU/dl preoperatively and 127 IU/dl postoperatively. Factor X fell from 90 IU/dl preoperatively to 50 IU/dl postoperatively. Total blood loss in 24 h in the mediastinal drains postoperatively was mean 673 ml, median 650 ml (range 250-2000). Reduction in thrombin potential correlated inversely with postoperative blood loss, r= -0.75 (Spearman correlation). The fall in the thrombin potential correlated with the prothrombin level (r = 0.75) and factor X (r = 0.47).
Davidson
Simon J
SJ
Departments of Haematology, Anaesthetics and Surgery, Royal Brompton Hospital, London, UK. s.davison@rbh.nthames.nhs.uk
Burman
John F
JF
Philips
Sophia M
SM
Onis
Simon J
SJ
Kelleher
Andrea A
AA
De Souza
Anthony C
AC
Pepper
John R
JR
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology; D001779:Blood Coagulation Factors / Q000032:analysis* / Q000187:drug effects / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000209:etiology; D013917:Thrombin / Q000032:analysis* / Q000187:drug effects
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D006493:Heparin; D013917:Thrombin