[The effect of reinfusion of mediastinal blood drained after coronary surgery on coagulation, fibrinolysis and volume of blood products transfused].
The aim of the study was to assess the effect of reinfusion of shed mediastinal blood on coagulation and volume of blood products transfused postoperatively. In the first retrospective part of the study, two groups of patients were compared with regard to postoperative blood loss and volume of blood products transfused postoperatively. The study group comprised 260 patients who received drained mediastinal blood. The control group comprised 277 patients who did not receive drained mediastinal blood postoperatively. Volumes of blood lost and transfused were similar in both groups (Tab. 2). The percentage of patients who avoided homologous transfusions was slightly lower in the study group, but the difference did not reach statistical significance (Fig. 1). Two subgroups with drainage higher than usual were compared and no significant differences were found (Tab. 3). In the second prospective part, the effect of postoperative autotransfusion on coagulation and fibrinolysis was studied. The study (autotransfusion) group consisted of 39 patients. The control group consisted of 28 patients. Coagulation tests done in both groups are listed in Tab. 1. Statistically significant differences were disclosed for prothrombin time preoperatively (p = 0.024), activated partial thromboplastin time preoperatively (p = 0.0029), and after 4 (p = 0.0046) and 8 hours (p = 0.0238) from surgery. The most notable differences were found for D-dimers. The level of D-dimers 4 hours after operation and reinfusion of mediastinal blood rose to an average of 22617 ng/mL, in comparison with 3419 ng/mL after 4 hours from surgery in the control group (statistically significant). However, after deduction of D-dimers transfused with mediastinal blood, the mean corrected concentration of D-dimers was 7000 ng/mL and was not significantly higher than in the control group (Tab. 4). The consecutive levels of D-dimers in the study group, though significantly higher than in the control group, tended to decrease, indicating that reinfusion did not contribute to activation of fibrynolysis (Fig. 2). It was therefore concluded that reinfusion of shed mediastinal blood allowed for a slight reduction in the volume of blood products transfused in the study group and did not affect coagulation.
Szczerkowski
Paweł
P
Z Kliniki Kardiochirurgii Pomorskiej Akademii Medycznej w Szczecinie, ul. Unii Lubelskiej 1, 71-252 Szczecin.
D001780:Blood Coagulation Tests; D001804:Blood Transfusion, Autologous; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D