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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 94-107, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SF Khuri, JA Wolfe, M Josa, TC Axford, I Szymanski, S Assousa, G Ragno, M Patel, A Silverman and M Park
The hemostatic dysfunction induced by cardiopulmonary bypass is due, in
part, to a platelet dysfunction evidenced by a postoperative extension of
the bleeding time; it leads to increased postoperative blood loss and
morbidity. This study, which was conducted in 85 patients undergoing
cardiopulmonary bypass, was designed to characterize the hematologic
changes during and after cardiopulmonary bypass and to elucidate the
relationships between these changes, the extension of the bleeding time,
and the magnitude of the postoperative nonsurgical blood loss. Variables
were measured before, during, and 2, 24, 48, and 72 hours after
cardiopulmonary bypass. Univariate and multivariate analyses were performed
with either the 2-hour postbypass bleeding time or the 4-hour postbypass
blood loss as the dependent variables. The reversal of the extension of the
bleeding time in the postoperative period was accompanied by a significant
increase in the mean platelet volume and by a significant increase in the
level of thromboxane B2 measured in the blood shed from the site of the
bleeding time determination. The postoperative bleeding time correlated
with the postoperative blood loss, and both parameters were dependent on
the duration of cardiopulmonary bypass. In addition, the postoperative
bleeding time correlated with the skin temperature and the plasma level of
D-dimer, while the postoperative blood loss also correlated with
temperature and the plasma levels of C3. These data establish a direct
relationship between the postoperative bleeding time, the postoperative
blood loss, and temperature. They indicate that the reversal of the
postoperative extension of the bleeding time is due in part to rewarming
and to the release of larger platelets into the circulation, and they
suggest that hyperfibrinolysis and complement activation may play an
important role in the cardiopulmonary bypass-induced platelet dysfunction.
ARTICLES
Hematologic changes during and after cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical blood loss
Department of Surgery, Brockton/West Roxbury Veterans Administration Medical Center, Mass.
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