Fibrinogen and FXIII activity correlate with bleeding after cardiac surgery
MedWire News: Plasma levels of fibrinogen and coagulation factor XIII (FXIII) activity correlate inversely with postoperative blood loss in patients undergoing coronary artery bypass graft (CABG) surgery, a Swedish study has found.
The researchers also report significant variation in plasma activity of individual coagulation factors after CABG.
To describe the activity of individual coagulation factors and their relation to bleeding volume after cardiac surgery, a team led by Anders Jeppsson from Sahlgrenska University Hospital in Gothenburg, analyzed plasma activity of coagulation factors and blood loss in 57 CABG patients.
The researchers determined plasma concentrations of fibrinogen, and plasma activity of FII, FV, FVII, FVIII, FIX, FX, FXI, and FXIII, adjusted for hemodilution, before and 2 and 24 hours after surgery.
Compared with preoperative baseline, there were significant reductions after 2 hours in adjusted plasma concentrations of fibrinogen (14%), and plasma activity of FII (9%), FV (13%), FX (13%) and FXIII (9%). FVII and FXI were not significantly changed, while there were significant increases in FVIII (23%) and FIX (23%).
Twenty-four hours after surgery there were significant increases in fibrinogen (45%), FVIII (93%), and FIX (33%), while FVII (37%), FXI (4%), and FXIII (6%) were decreased.
Median postoperative blood loss was 380 ml/12 hours. There were significant inverse correlations between postoperative blood loss and fibrinogen concentration 2 hours after surgery and between postoperative blood loss and pre- and postoperative FXIII activity, but not between blood loss and any of the other factors.
Writing in the journal Thrombosis Research, the researchers suggest the variation in plasma activity of individual coagulation factors, "demonstrates either a disparity in consumption of coagulation factors during cardiac surgery, or a difference in how fast new generation of the coagulation factors occurs."
Noting that the only factors to correlate with bleeding volume were fibrinogen and FXIII, which are both involved in clot stability, they suggest: "Therapeutic measures, aimed to improve clot stability, may be effective to prevent or treat bleeding complications after cardiac surgery."
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By Joel Levy