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Ann Thorac Surg 1991;52:250-257
© 1991 The Society of Thoracic Surgeons

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Articles

Preoperative hemostatic activity and excessive bleeding after cardiopulmonary bypass

Department of Cardiothoracic Surgery and The Thrombosis Unit, St. Bartholomew's Hospital, London, England

Accepted for publication April 13, 1991.

^_* Address reprint requests to Mr Ratnatunga, Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, England.

The rationale for predicting the risk of excessive postoperative bleeding by assessing the hemostatic status of a patient before cardiopulmonary bypass was investigated. A novel, rapid, overall test (hemostatometry) consisting of a physiologically relevant test of platelet function (shear-induced hemostasis) and coagulation was performed using nonanticoagulated blood and compared with the routine coagulation screen. Two hundred five patients undergoing elective coronary revascularization were studied 3 to 4 days before operation. Forty-nine bled excessively for nonsurgical reasons; none were predicted by the routine coagulation tests. Using a stepwise discriminant analysis, hemostatometry correctly predicted 39 of 49 (63%). Thirty of 156 predicted as bleeders by hemostatometry did not bleed. Thus, preoperative hemostatometry predicted 77% of the true outcome. The false predictions suggest, however, that certain bleeding abnormalities probably acquired during cardiopulmonary bypass cannot be predicted. These findings do not justify the routine use of preoperative tests in assessing the bleeding risk in patients undergoing cardiopulmonary bypass.

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