Hemostatic and fibrinolysis markers in serum and shed mediastinal blood after elective coronary artery bypass grafting

Objective

Reduction of homologous blood products in cardiac surgery is mainly achieved by autologous blood salvage. One of the most customary methods consists in autotransfusion of shed mediastinal blood within the first 6 hours after surgery. Aim of this prospective study was to compare serum and shed mediastinal blood qualities of hemostatic and fibrinolysis markers early after elective coronary artery bypass grafting (CABG).

Methods

Forty-seven patients (mean age 68.1 ± 6.9, 15 female/ 32 male) underwent first-time elective CABG with extracorporal circulation via median sternotomy. Activated partial thromboplastin time (aPTT), prothrombin time (Quick's value), international normalized ratio (INR), thrombin time, and fibrinogen (factor I) in arterial blood and shed mediastinal blood were measured after admission to the ICU and 6 hours after unclamping the aorta.

Results

Mean loss of mediastinal shed blood was 207 ± 127 ml within the first 6 hours after unclamping the aorta. All tests showed that the shed mediastinal blood contained significantly elevated concentrations or activities of all biochemical parameters indicating blood activation or clotting (Table 1).

Table 1

Conclusions

Mediastinal shed blood is excessively activated regarding coagulation and fibrinolysis. In patients undergoing transfusion of higher quantities of shed blood might cause postoperative excessive bleeding.