Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden.
Thromb Res. 2010 Aug;126(2):e128-33. doi: 10.1016/j.thromres.2010.05.028. Epub 2010 Jun 26.
Hemodilution and consumption of coagulation factors during cardiopulmonary bypass has been suggested to contribute to bleeding complications after cardiac surgery. The aim was to describe the activity of individual coagulation factors after CABG in relation to hemodilution and postoperative bleeding.
Plasma concentrations of fibrinogen and plasma activity of FII, FV, FVII, FVIII, FIX, FX, FXI and FXIII adjusted for hemodilution were analysed in 57 CABG patients before, and 2h and 24h after surgery. Postoperative bleeding was registered and correlations to coagulation factor activity were calculated.
Adjusted plasma concentration of fibrinogen (-14+/-6%), and plasma activity of FII (-9+/-6%), FV (-13+/-8%), FX (-13+/-7%) and FXIII (-9+/-14%) were reduced two hours after surgery compared to baseline (all p<0.001). FVII (+3+/-12%, p=0.34) and FXI (+1+/-19%, p=0.50) were unchanged, while FVIII (+23+/-44%, p=0.006) and FIX (+23+/-17%, p<0.001) increased. Twenty-four hours after surgery fibrinogen (+45+/-27%), FVIII (+93+/-66%) and FIX (+33+/-26%) were all increased (all p<0.001), while FVII (-37+/-14%, p<0.001), FXI (-4+/-18%, p=0.02) and FXIII (-6+/-15%, p=0.004) were decreased. Median postoperative blood loss was 380 ml/12h. There were significant inverse correlations between postoperative blood loss and fibrinogen concentration 2h after surgery (r=-0.33, p=0.019) and between postoperative blood loss and pre- and postoperative FXIII activity (r=-0.34, p=0.009 and r=-0.41, p=0.003, respectively), but not between blood loss and any of the other factors.
There is a marked dissociation in plasma activity of individual coagulation factors after CABG. Plasma concentration of fibrinogen and factor XIII activity correlates inversely to postoperative blood loss after CABG.
体外循环过程中血液稀释和凝血因子的消耗被认为是心脏手术后出血并发症的原因。本研究旨在描述冠状动脉旁路移植术（CABG）后单个凝血因子的活性与血液稀释和术后出血的关系。
对 57 例行 CABG 的患者在术前、术后 2 小时和 24 小时时的纤维蛋白原血浆浓度和经过血液稀释调整的 FII、FV、FVII、FVIII、FIX、FX、FXI 和 FXIII 的血浆活性进行分析。记录术后出血量，并计算与凝血因子活性的相关性。
与基线相比，术后 2 小时时纤维蛋白原（-14±6%，p<0.001）和 FII（-9±6%，p<0.001）、FV（-13±8%，p<0.001）、FX（-13±7%，p<0.001）和 FXIII（-9±14%，p<0.001）的血浆活性降低。FVII（+3±12%，p=0.34）和 FXI（+1±19%，p=0.50）无变化，而 FVIII（+23±44%，p=0.006）和 FIX（+23±17%，p<0.001）增加。术后 24 小时时，纤维蛋白原（+45±27%，p<0.001）、FVIII（+93±66%，p<0.001）和 FIX（+33±26%，p<0.001）均升高，而 FVII（-37±14%，p<0.001）、FXI（-4±18%，p=0.02）和 FXIII（-6±15%，p=0.004）降低。术后 12 小时的中位出血量为 380ml。术后 2 小时时，纤维蛋白原浓度与术后出血量呈显著负相关（r=-0.33，p=0.019），而术后 FXIII 活性与术前和术后出血量均呈显著负相关（r=-0.34，p=0.009 和 r=-0.41，p=0.003），但与其他因子均无相关性。
CABG 后单个凝血因子的血浆活性存在明显分离。CABG 后纤维蛋白原浓度和 FXIII 活性与术后出血量呈负相关。
