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Submitted: 22 November 2018 Modified: 22 November 2018
HERDIN Record #: NCR-PHC-18112216542116

Association of coagulation tests with significant postoperative bleeding among pediatric patients undergoing cardiopulmonary bypass.

Rogelyn  . Tapuro-Olais,

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Background: Excessive bleeding after cardiopulmonary bypass (CPB) continues to be an important cause of morbidity and mortality for both adult and pediatric population.


Objectives: 1) To compare the demographics and CPB characteristics of cyanotic and acyanotic patients; 2) To determine the incidence of significant postoperative bleeding among pediatric patients with cyanotic and acyanotic heart disease undergoing CPB; 3) To determine the association of PT, aPTT levels and platelet count with significant postoperative bleeding among pediatric patients with cyanotic and acyanotic heart disease undergoing CPB; 4) To determine the correlation of PT, aPTT levels and platelet count with blood product transfusion among pediatric patients with cyanotic and acyanotic heart disease undergoing CPB.


Methods: Retrospective cross-sectional study was performed. The charts of pediatric patients who underwent elective open heart surgery from January 2010 to December 2011 were reviewed. Patients were divided into two groups- patients cyanotic lesions and patients with acyanotic lesions. The patients were categorized with significant postoperative bleeding based on their respective chest tube drainages recorded at the RR for 24 hours. The blood products transfused were noted. The PT and aPTT, and Platelet count were noted. The cyanotic and acyanotic patients were evaluated separately. Pearson correlation was used to determine the relationship between coagulation tests with the amount of blood products transfused. A p-value  0.050 was considered statistically significant.


Results: The study included 52 cyanotic patients and 57 acyanotic patients. There was 9.61% incidence of significant postoperative bleeding among cyanotic heart disease patients and 1.75% among acyanotic heart disease patients. Among the patients with cyanotic heart disease, the preoperative platelet count is correlated with the amount of platelet concentrate that was transfused with correlation coefficient of 0.802 with p value of 0.000. While in patients with acyanotic heart disease, both preoperative platelet count and amount of platelet concentrate that was transfused, preoperative aPTT and amount of transfused FFP are correlated with correlation coefficient of -0.409 and p value of 0.002 and 0.615 and p value of 0.03, respectively.


Conclusion: There is higher incidence of significant postoperative bleeding in cyanotic patients. There is no significant difference in the levels of PT, aPTT and platelet count of patients who had significant postoperative bleeding compared to those without significant postoperative bleeding, both in cyanotic and acyanotic heart disease. In patients with congenital heart disease, preoperative platelet count is correlated with the amount of platelet concentrate transfused but in patients with acyanotic heart disease, the preoperative aPTT is correlated with the amount of FFP transfused.

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Philippine Heart Center Medical Library PHC.R.007.12 Fulltext Print Format

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