Impact of Sonoclot hemostasis analysis after cardiopulmonary bypass on postoperative hemorrhage in cardiac surgery.
OBJECTIVE
The Sonoclot Analyzer provides a functional test of whole blood coagulation by measuring the viscous property of the blood sample. In this study, we used a modified Sonoclot assay, using cuvettes with a glass bead activator containing heparinase, and compared the Sonoclot data before and after cardiopulmonary bypass (CPB) to assess the usefulness in predicting postoperative hemorrhage.


METHODS
In 41 cardiac surgery patients, Sonoclot data were obtained immediately after heparin administration (pre-bypass) and just before protamine administration (post-bypass). Excessive bleeding was defined as chest tube drainage greater than 2 ml.kg(-1).h(-1) in 1 h during the first 4 h after surgery.


RESULTS
There were no significant differences in Sonoclot values before and after CPB in patients with acceptable bleeding (n = 29). In patients with excessive bleeding (n = 12), Sonoclot variables reflecting fibrin formation (activated clotting time [ACT], rate of fibrin formation [clot rate], and peak clot signal) were preserved after CPB; however, the variables reflecting platelet-fibrin interaction (time to peak, peak angle, and clot retraction rate) were significantly different from their respective pre-bypass values. Sonoclot analysis showed impairment of clot maturation after CPB in patients with excessive postoperative bleeding.


CONCLUSIONS
Our results suggest that abnormal postoperative hemorrhage can be predicted by Sonoclot analysis with a new glass bead-activated heparinase test performed after CPB.
Yamada
Tatsuya
T
Department of Anesthesiology, School of Medicine, Keio University, 35 Shinanomachi, Tokyo 160-8582, Japan.
Katori
Nobuyuki
N
Tanaka
Kenichi A
KA
Takeda
Junzo
J
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests / Q000379:methods*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006470:Hemorrhage / Q000517:prevention & control*; D006487:Hemostasis; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*