The effect of continuous elimination methods on the hemostatic profile of a cardiac surgery patient monitored using thromboelastography.
BACKGROUND
This work is focused on mapping issues of hemostasis in patients during continuous renal replacement therapy, or the possible impact of the use of anticoagulants.


METHODS
The study included 30 consecutive patients requiring continuous renal replacement therapy following cardiac surgery in the period of 2009 to 2012. Patients were placed into 2 branches according to the selected method of anticoagulation (regional citrate anticoagulation-RCA, unfractionated heparin UFH). According to the given scheme (t1-t7) thromboelastography and laboratory testing related to the testing of blood clotting during continuous renal replacement therapy were performed.


RESULTS
The average lifespan of a hemofilter during continuous renal replacement is 58.13 ± 9.968 hours. During continuous renal replacement therapy there are significant changes in the initiation of coagulation according to thromboelastographic parameters (R, K, alpha angle) in both branches of anticoagulation. The maximum image changes in hemostasis occur around 24 hours (t4) from the start of the procedure. The nature of the changes is the procoagulant activity in these parameters. In the branch of regional citrate anticoagulation a higher value of functional fibrinogen is apparent. There was no significant difference in the activation of native blood between UFH and RCA.


CONCLUSIONS
During continuous renal replacement therapy significant changes occur in the thromboelastographic image and the laboratory parameters in blood clotting. The nature of the change is the procoagulant activity. The question remains about the complexity of the changes that TEG is not able to detect, especially in the cellular area.
Department of Cardiac Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc - Czech Republic.
Ondřej
O
Zuščich
Department of Cardiac Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc - Czech Republic.
Roman
R
Hájek
Department of Intensive Care Medicine and Forensic Studies/Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Ostrava, Ostrava - Czech Republic.
Pavel
P
Ševčík
Department of Cardiac Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc - Czech Republic.
Vladimír
V
Lonský
Department of Biomedicine and Statistics, Faculty of Medicine and Dentistry, Palacky University, Olomouc - Czech Republic.
Jana
J
Zapletalová
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D006348:Cardiac Surgical Procedures; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006493:Heparin / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D013916:Thrombelastography; D013927:Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin