title: Excessive bleeding predictors after cardiac surgery in adults: integrative review.
abstract: OBJECTIVE
  To integrate literature data on the predictors of excessive bleeding after cardiac surgery in adults.
  
  
  BACKGROUND
  Perioperative nursing care requires awareness of the risk factors for excessive bleeding after cardiac surgery to assure vigilance prioritising and early correction of those that are modifiable.
  
  
  METHODS
  Integrative literature review.
  
  
  METHODS
  Articles were searched in seven databases. Seventeen studies investigating predictive factors for excessive bleeding after open-heart surgery from 2004-2014 were included.
  
  
  RESULTS
  Predictors of excessive bleeding after cardiac surgery were: Patient-related: male gender, higher preoperative haemoglobin levels, lower body mass index, diabetes mellitus, impaired left ventricular function, lower amount of prebypass thrombin generation, lower preoperative platelet counts, decreased preoperative platelet aggregation, preoperative platelet inhibition level >20%, preoperative thrombocytopenia and lower preoperative fibrinogen concentration. Procedure-related: the operating surgeon, coronary artery bypass surgery with three or more bypasses, use of the internal mammary artery, duration of surgery, increased cross-clamp time, increased cardiopulmonary bypass time, lower intraoperative core body temperature and bypass-induced haemostatic disorders. Postoperative: fibrinogen levels and metabolic acidosis.
  
  
  CONCLUSIONS
  Patient-related, procedure-related and postoperative predictors of excessive bleeding after cardiac surgery were identified.
  
  
  CONCLUSIONS
  The predictors summarised in this review can be used for risk stratification of excessive bleeding after cardiac surgery. Assessment, documentation and case reporting can be guided by awareness of these factors, so that postoperative vigilance can be prioritised. Timely identification and correction of the modifiable factors can be facilitated.
authors.affiliation: Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), São Paulo, SP, Brazil.|School Hospital, São Paulo University (HU-USP), São Paulo, SP, Brazil.
authors.forename: Camila Takao
authors.initials: CT
authors.lastname: Lopes
authors.affiliation: School Hospital, São Paulo University (HU-USP), São Paulo, SP, Brazil.|School of Nursing, São Paulo University (EEUSP), São Paulo, SP, Brazil.
authors.forename: Talita Raquel
authors.initials: TR
authors.lastname: Dos Santos
authors.affiliation: Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), São Paulo, SP, Brazil.|ICU I, Dante Pazzanese Cardiology Institute (IDPC), São Paulo, SP, Brazil.
authors.forename: Evelise Helena Fadini Reis
authors.initials: EH
authors.lastname: Brunori
authors.affiliation: College of Nursing, The University of Iowa, Iowa City, IA, USA.
authors.forename: Sue A
authors.initials: SA
authors.lastname: Moorhead
authors.affiliation: Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Juliana de Lima
authors.identifier: http://orcid.org/0000-0001-6915-6781
authors.initials: Jde L
authors.lastname: Lopes
authors.affiliation: Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Alba Lucia Bottura Leite de
authors.initials: AL
authors.lastname: Barros
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005340:Fibrinogen; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D005340:Fibrinogen
keywords: bleeding; cardiac surgery; cardiac surgical procedures; haemorrhage; nursing; postoperative haemorrhage; risk factors; thoracic surgery