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Ann Thorac Surg 1994;58:216-221
© 1994 The Society of Thoracic Surgeons

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Articles

Predictive value of blood clotting tests in cardiac surgical patients

^a Section of Cardiothoracic Anesthesia, Department of Anesthesia The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina USA
^b Department of Cardiothoracic Surgery The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina USA
^c Section of Hematology and Oncology, Department of Medicine The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina USA
^d Department of Biostatistics, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina USA

Accepted for publication November 30, 1993.

^_* Address reprint requests to Dr Gravlee. Department of Anesthesiology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212.

This study ptospectively evaluated numerous tests of clolting function in 897 consecutive adult cardiac surgical patients over 18 months. This included coronary operation, valve replacement, and reoperative patients. The tests included activated clotting time, activated partial thromboplastin time, prothrombin time, thiombin time, fibrinogen, fibrin/fibrinogen degradation products, platelet count, and Duke's earlobe bleeding time. Other variables such as age, sex, and cardiopulmonary bypass duration were included in the multivariate analysis. Statistically significant correlations were found between 16-hour mediastinal drainage and activated partial thromboplastin time, fibrinogen, activated clotting time, fibrin/fibrinogen degradation products, platelet count, and prothrombin time. Scatter plots indicate that these relationships, although statistically significant, had little predictive value and were largely significant is a result of the large number of patients in each group, which permitted weak correlations to reach statistical significance. The best multivariate model constructed could explain only 12% of the observed variation in postoperative blood loss. Because the predictive values of the tests are so low, it does not appear sensible to screen patients routinely using these clotting tests shortly after cardiopulmonary bypass.

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