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Transfusion for Coagulopathy After Heart Surgery: Efficacy of Laboratory Studies

Division of Cardiothoracic Surgery University of California at San Francisco San Francisco, California, USA The Robert Wood Johnson Medical School New Brunswick, New Jersey, USA
Timothy S Hall, MD Tel: 1 415 476 3503 Fax: 1 415 840 0269 email: hallt{at}surgery.ucsf.edu Division of Cardiothoracic Surgery, University of California at San Francisco, 533 Parnassus Avenue, U-119, San Francisco CA 94143-1267, USA.

Limited information exists regarding transfusions specifically for coagulopathy following cardiac surgery and the value of pre- and postoperative coagulation tests. Procedures (86% coronary bypass, 7.5% valve, and 6.5% combined valve and bypass) on 478 patients were reviewed; 101 patients (21%) were transfused for postoperative coagulopathy. Compared to those not transfused, patients with coagulopathy were significantly older and smaller, and they had more combined valve procedures, emergency operations, and preoperative heparin treatment as well as longer crossclamp and bypass times. Three preoperative tests showed significant differences in the coagulopathy group: activated clotting time, partial thromboplastin time, and antithrombin-III level. Four postoperative tests showed significant differences between the groups: prothrombin time, partial thromboplastin time, fibrinogen level, and fibrin split products at 10 dilutions. Patient characteristics and pre- and postoperative testing can identify patients at high risk of transfusion specifically related to coagulopathy.