Full Length ArticleRational and timely haemostatic interventions following cardiac surgery - coagulation factor concentrates or blood bank products

- The effect of blood bank products compared to coagulation factor concentrates
- Characteristics of cardiac coagulopathy dynamically change postoperative.
- Coagulation factor concentrates were more efficient in correcting the coagulopathy.
- Composition of effective hemostatic intervention changed over time.

BackgroundCardiac surgery may cause a serious coagulopathy leading to increased risk of bleeding and transfusion demands. Blood bank products are commonly first line haemostatic intervention, but has been associated with hazardous side effect. Coagulation factor concentrates may be a more efficient, predictable, and potentially a safer treatment, although prospective clinical trials are needed to further explore these hypotheses. This study investigated the haemostatic potential of ex vivo supplementation of coagulation factor concentrates versus blood bank products on blood samples drawn from patients undergoing cardiac surgery.Methods30 adults were prospectively enrolled (mean age = 63.9, females = 27%). Ex vivo haemostatic interventions (monotherapy or combinations) were performed in whole blood taken immediately after surgery and two hours postoperatively. Fresh-frozen plasma, platelets, cryoprecipitate, fibrinogen concentrate, prothrombin complex concentrate (PCC), and recombinant FVIIa (rFVIIa) were investigated. The haemostatic effect was evaluated using whole blood thromboelastometry parameters, as well as by thrombin generation.ResultsImmediately after surgery the compromised maximum clot firmness was corrected by monotherapy with fibrinogen or platelets or combination therapy with fibrinogen. At two hours postoperatively the coagulation profile was further deranged as illustrated by a prolonged clotting time, a reduced maximum velocity and further diminished maximum clot firmness. The thrombin lagtime was progressively prolonged and both peak thrombin and endogenous thrombin potential were compromised. No monotherapy effectively corrected all haemostatic abnormalities. The most effective combinations were: fibrinogen + rFVIIa or fibrinogen + PCC. Blood bank products were not as effective in the correction of the coagulopathy.ConclusionCoagulation factor concentrates appear to provide a more optimal haemostasis profile following cardiac surgery compared to blood bank products.