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Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

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Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management

Agnese Ozolina1 / Eva Strike1, / Vladimirs Harlamovs1 / Nora Porite1

Department of Anesthesiology and Cardiothoracic Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia1

Riga Stradins University, Latvia2

This content is open access.

Citation Information: Acta Chirurgica Latviensis. Volume 9, Issue 1, Pages 86–91, ISSN (Print) 1407-981X, DOI: 10.2478/v10163-010-0017-2, August 2010

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Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management

Postoperative bleeding is a concern for all patients undergoing cardiac surgery. In patients exposed to cardiopulmonary bypass, bleeding following surgery is excessive in up to twelve percent of patients in whom subsequent re-exploration is required. Several studies have evaluated main reasons, prevention of excessive postoperative bleeding and impact of patients outcomes. This article contains a literature review on excessive bleeding and re-exploration following cardiac surgery, main surgical and medical sources, prevention and management of bleeding.

Keywords: re-exploration; bleeding; cardiac surgery

  • Abrishami A, Chung F, Wong J. Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis // Can J Anaesth, 2009; 56:202-12 [PubMed]

  • Abul-Azm A, Abdullah KM. Effect of topical tranexamic acid in open heart surgery // Eur J Anaesthesiol, 2006; 23:380-4 [CrossRef]

  • Andreasen J, Nielsen C. Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass // Eur J Cardiothorac Surg, 2004; 26:311-7 [PubMed] [CrossRef]

  • Anthi A et al. Unexpected cardiac arrest after cardiac surgery: incidence, predisposing causes, and outcome of open chest cardiopulmonary resuscitation // Chest, 1998; 113:15-9

  • Balachandran S et al. Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery // Ann Thorac Surg, 2002; 73:1912-8 [PubMed]

  • Casati V et al. Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: Comparison between on-pump and off-pump techniques // J Thorac Cardiovasc Surg, 2004; 128:83-91

  • Casati V et al. Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery // Ann Thorac Surg, 1999; 68:2252-6; discussion 2256-7

  • Chandler WL. Effects of hemodilution, blood loss, and consumption on hemostatic factor levels during cardiopulmonary bypass // J Cardiothorac Vasc Anesth, 2005; 19:459-67 [CrossRef]

  • Chen L et al. Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting // J Thorac Cardiovasc Surg, 2004; 128:425-31

  • Choong CK et al. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes // Eur J Cardiothorac Surg, 2007; 31:834-8 [CrossRef] [PubMed]

  • Barica D et al. Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective randomize study // Ann Thorac Surg, 2005; 27:592-598

  • De Bonis M et al. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study // J Thorac Cardiovasc Surg, 2000; 119:575-80

  • Dial S et al. Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass // J Thorac Cardiovasc Surg, 2005; 130:654-61

  • Duggan E et al. Coagulopathy after cardiac surgery may be influenced by a functional plasminogen activator inhibitor polymorphism // Anesth Analg, 2007; 104:1343-7

  • Dunne JR et al. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery // J Surg Res, 2002; 102:237-44 [PubMed]

  • Ereth MH et al. Does the platelet-activated clotting test (HemoSTATUS) predict blood loss and platelet dysfunction associated with cardiopulmonary bypass // Anesth Analg, 1997; 85:259-64 [PubMed]

  • Fiser SM et al. Cardiac reoperation in the intensive care unit // Ann Thorac Surg, 2001; 71(6):1888-92; discussion 1892-3

  • Flom-Halvorsen HI et al. Quality of intraoperative autologous blood withdrawal used for retransfusion after cardiopulmonary bypass // Ann Thorac Surg, 2003; 76:744-8; discussion 748

  • Hall TS et al. Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes // Ann Thorac Cardiovasc Surg, 2001; 7:352-7 [PubMed]

  • Hirose H, Takahashi A. Re-exploration for bleeding after coronary artery bypass grafting: what is the acceptable range of re-exploration rate // Ann Thorac Cardiovasc Surg, 2002; 8:248-9; author reply 249

  • Karkouti K et al. Comprehensive Canadian review of the off-label use of recombinant activated factor VII in cardiac surgery // Circulation, 2008; 118: 331-8

  • Karkouti K et al. Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery // Ann Thorac Surg, 2005; 80:1381-7 [PubMed]

  • Karkouti K et al. Prediction of massive blood transfusion in cardiac surgery. Can J Anaesth, 2006; 53:781-94

  • Karthik S et al. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay // Ann Thorac Surg, 2004; 78:527-34; discussion 534

  • Kinduris S et al. Bleeding after cardiac surgery: risk factors, frequency, and outcomes // Medicina, 2006; 42:566-70

  • Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood transfusion as the outcome. The International Study of Peri-operative Transfusion (ISPOT) Investigators // Anesth Analg, 1997; 85:1258-67 [PubMed]

  • Levi M et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints // Lancet, 1999; 354:1940-7

  • Mangano DT, Tudor IC, Dietzel C. The risk associated with aprotinin in cardiac surgery // N Engl J Med, 2006; 354:353-65

  • Pifarre R et al. Management of postoperative heparin rebound following cardiopulmonary bypass // J Thorac Cardiovasc Surg, 1981; 81:378-81

  • Purandare SV et al. Heparin rebound-a cause of bleeding following open heart surgery // J Postgrad Med, 1979; 25:70-4

  • Ranucci M et al. Surgical reexploration after cardiac operations: why a worse outcome // Ann Thorac Surg, 2008; 86:1557-62 [CrossRef] [PubMed]

  • Rich JB. The efficacy and safety of aprotinin use in cardiac surgery // Ann Thorac Surg, 1998; 66:S6-11; discussion S25-8 [CrossRef]

  • Riess HB et al. Prothrombin complex concentrate (Octaplex) in patients requiring immediate reversal of oral anticoagulation // Thromb Res, 2007; 121: 9-16

  • Salis S et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery // J Cardiothorac Vasc Anesth, 2008; 22:814-22 [CrossRef]

  • Sirvinskas E et al. Influence of early re-infusion of autologous shed mediastinal blood on clinical outcome after cardiac surgery // Perfusion, 2007; 22:345-52 [PubMed] [CrossRef]

  • Wolfe R et al. Monitoring the rate of re-exploration for excessive bleeding after cardiac surgery in adults // Qual Saf Health Care, 2007; 16:192-6 [CrossRef] [PubMed]

  • Zabeeda D et al. Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization // Ann Thorac Surg, 2002; 74:733-8 [PubMed] [CrossRef]

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