TY - JOUR
T1 - Protracted fibrinolysis resistance following cardiac surgery with cardiopulmonary bypass
T2 - A prospective observational study of clinical associations and patient outcomes
AU - Coupland, Lucy A.
AU - Pai, Kieran G.
AU - Pye, Sidney J.
AU - Butorac, Mark T.
AU - Miller, Jennene J.
AU - Crispin, Philip J.
AU - Rabbolini, David J.
AU - Stewart, Antony H.L.
AU - Aneman, Anders
N1 - Publisher Copyright:
© 2024 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
PY - 2024/7
Y1 - 2024/7
N2 - Background: Surgery on cardiopulmonary bypass (CPB) elicits a pleiomorphic systemic host response which, when severe, requires prolonged intensive care support. Given the substantial cross-talk between inflammation, coagulation, and fibrinolysis, the aim of this hypothesis-generating observational study was to document the kinetics of fibrinolysis recovery post-CPB using ClotPro® point-of-care viscoelastometry. Tissue plasminogen activator-induced clot lysis time (TPA LT, s) was correlated with surgical risk, disease severity, organ dysfunction and intensive care length of stay (ICU LOS). Results: In 52 patients following CPB, TPA LT measured on the first post-operative day (D1) correlated with surgical risk (EuroScore II, Spearman's rho.39, p <.01), time on CPB (rho =.35, p =.04), disease severity (APACHE II, rho =.52, p <.001) and organ dysfunction (SOFA, rho =.51, p <.001) scores, duration of invasive ventilation (rho =.46, p <.01), and renal function (eGFR, rho = −.65, p <.001). In a generalized linear regression model containing TPA LT, CPB run time and markers of organ function, only TPA LT was independently associated with the ICU LOS (odds ratio 1.03 [95% CI 1.01–1.05], p =.01). In a latent variables analysis, the association between TPA LT and the ICU LOS was not mediated by renal function and thus, by inference, variation in the clearance of intraoperative tranexamic acid. Conclusions: This observational hypothesis-generating study in patients undergoing cardiac surgery with cardiopulmonary bypass demonstrated an association between the severity of fibrinolysis resistance, measured on the first post-operative day, and the need for extended postoperative ICU level support. Further examination of the role of persistent fibrinolysis resistance on the clinical outcomes in this patient cohort is warranted through large-scale, well-designed clinical studies.
AB - Background: Surgery on cardiopulmonary bypass (CPB) elicits a pleiomorphic systemic host response which, when severe, requires prolonged intensive care support. Given the substantial cross-talk between inflammation, coagulation, and fibrinolysis, the aim of this hypothesis-generating observational study was to document the kinetics of fibrinolysis recovery post-CPB using ClotPro® point-of-care viscoelastometry. Tissue plasminogen activator-induced clot lysis time (TPA LT, s) was correlated with surgical risk, disease severity, organ dysfunction and intensive care length of stay (ICU LOS). Results: In 52 patients following CPB, TPA LT measured on the first post-operative day (D1) correlated with surgical risk (EuroScore II, Spearman's rho.39, p <.01), time on CPB (rho =.35, p =.04), disease severity (APACHE II, rho =.52, p <.001) and organ dysfunction (SOFA, rho =.51, p <.001) scores, duration of invasive ventilation (rho =.46, p <.01), and renal function (eGFR, rho = −.65, p <.001). In a generalized linear regression model containing TPA LT, CPB run time and markers of organ function, only TPA LT was independently associated with the ICU LOS (odds ratio 1.03 [95% CI 1.01–1.05], p =.01). In a latent variables analysis, the association between TPA LT and the ICU LOS was not mediated by renal function and thus, by inference, variation in the clearance of intraoperative tranexamic acid. Conclusions: This observational hypothesis-generating study in patients undergoing cardiac surgery with cardiopulmonary bypass demonstrated an association between the severity of fibrinolysis resistance, measured on the first post-operative day, and the need for extended postoperative ICU level support. Further examination of the role of persistent fibrinolysis resistance on the clinical outcomes in this patient cohort is warranted through large-scale, well-designed clinical studies.
KW - cardiopulmonary bypass surgery
KW - clot lysis time
KW - dysregulated host response
KW - fibrinolysis
KW - fibrinolysis resistance
KW - point-of-care testing
KW - viscoelastic testing
KW - Point-of-care testing
KW - Clot lysis time
KW - Cardiopulmonary bypass surgery
KW - Fibrinolysis
KW - Viscoelastic testing
KW - Dysregulated host response
KW - Fibrinolysis resistance
UR - http://www.scopus.com/inward/record.url?scp=85188551807&partnerID=8YFLogxK
U2 - 10.1111/aas.14409
DO - 10.1111/aas.14409
M3 - Article
SN - 0001-5172
VL - 68
SP - 772
EP - 780
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
IS - 6
ER -