title: Hypercoagulant Abdominal Swabs in Cardiac Surgery: Potential Problems and Background.
abstract: BackgroundDuring cardiac surgery with heart-lung-machine support, abdominal swabs are routinely used to adsorb blood from the operation field. In part, abdominal swabs exhibit procoagulant activity, which is usually considered harmless. However, coagulation induction and abnormal clot formation on the surface of abdominal swabs in the operation field may, if the blood is retransfused into the extracorporeal circuit, lead to severe thromboembolic complications. The aim of the present study was to elucidate the origin of the unexpected blood clotting upon contact with hypercoagulant swabs.MethodsThe coagulant properties of three abdominal swabs were characterized using a simple clotting test and human whole blood, which was anticoagulated with different heparin concentrations. Eluates prepared from the abdominal swabs and the color stabilizer polydiallyamine (PDAA) were incubated with blood and blood clotting was investigated. Furthermore, the effects of the abdominal swabs on blood clotting time and on heparin were investigated.ResultsOur data show that the three abdominal swabs as well as the respective eluates exhibit distinctive coagulant properties. The abdominal swab with the highest hypercoagulant effect significantly reduced blood clotting time and also led to a reduction in free heparin. PDAA does not induce activation of the coagulation system.ConclusionThe data indicate that the hypercoagulant swab reduces the clotting time and the concentration of free heparin. Abdominal swabs used during complex cardiac surgery with heart-lung-machine support should definitely be tested for their coagulant properties using appropriate tests before clinical applications, as it cannot be specified what leads to their hypercoagulant property.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Krajewski
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Hierlemann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Neumann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Nathan
authors.affiliation: Medical & Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Rengsdorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Abel
authors.affiliation: Medical & Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Rengsdorf, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Koggel
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Wendel
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D003029:Coagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006355:Heart-Lung Machine; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D008422:Materials Testing; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D015503:Surgical Sponges / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D003029:Coagulants; D006493:Heparin