WARFARIN PRETREATMENT DOES NOT LEAD TO INCREASED BLEEDING TENDENCY DURING CARDIAC-SURGERY

被引：31
作者：
DIETRICH, W
DILTHEY, G
SPANNAGAL, M
RICHTER, JA
机构：
[1] Department of Anesthesia, German Heart Center Munich
来源：
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA | 1995年 / 9卷 / 03期
关键词：
WARFARIN; APROTININ; BLEEDING; HEMOSTASIS;
D O I：
10.1016/S1053-0770(05)80316-7
中图分类号：
R614 [麻醉学];
学科分类号：
100217 ;
摘要：
Objective: To study the influence of preoperative warfarin anticoagulation on postoperative blood loss and allogeneic blood requirement. Design: Retrospective study with a matched control group. Setting: University and community hospital, single institutional. Participants: 240 patients scheduled for cardiac surgery. Interventions: Warfarin sodium was administered to 125 patients preoperatively to prevent thromboembolic complications of their underlying heart disease, 115 served as control. Approximately half of the patients in each group received aprotinin treatment during operation. Measurement and Main Results: The international normalized ratio (INR) of the prothrombin time was preoperatively 2.4 (95% confidence interval [CI 0.95]: 2.3 to 2.6) in the warfarin group and 1.1 (CI 0.95: 1.0 to 1.1) in the control group (p < 0.05), and postoperatively 1.9 (CI 0.95: 1.8 to 2.1) (warfarin) and 1.5 (CI 0.95: 1.4 to 1.5) (control) (p < 0.05). The postoperative blood loss after 6 and 12 hours was 381 (CI 0.95: 329 to 434)/505 (CI 0.95: 439 to 571) mL (warfarin) compared with 472 (CI 0.95: 403 to 541)/612 (CI 0.95: 527 to 697) mL. (control) (p < 0.05). This difference was blunted when the proteinase inhibitor aprotinin was used. Neither preoperative nor postoperative prothrombin time correlated with blood loss. Despite lower heparin consumption the activated coagulation time (ACT) during CPB was significantly prolonged in the warfarin group. Conclusions: Warfarin pretreatment does not lead to increased bleeding but may even have a beneficial anticoagulant effect that may lead to better preserved postoperative hemostasis and reduced blood loss. Copyright (C) 1995 by W.B. Saunders Company
引用
收藏
页码：250 / 254
页数：5
相关论文
共 26 条
  • [11] Fuster, Badimon, Badimon, Et al., Prevention of thromembolism induced by prosthetic heart valves, Semin Thromb Hemost, 14, pp. 50-56, (1988)
  • [12] Khuri, Wolfe, Josa, Et al., Hematologic changes during and after cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical blood loss, J Thorac Cardiovasc Surg, 104, pp. 94-107, (1992)
  • [13] Winters, Santoro, Miletich, Et al., Relative importance of thrombin compared with plasmin-mediated platelet activation in response to plasminogen activation with streptokinase, Circulation, 84, pp. 1552-1560, (1991)
  • [14] Venturini, Kaplan, Thrombin induced platelet adhesion to endothelial cells, Semin Thromb Hemostas, 18, pp. 275-283, (1992)
  • [15] Torr, Eisenberg, Sobel, The dependence of activation of platelets by a plasminogen activator on the evolution of thrombin activity, Thromb Res, 64, pp. 435-444, (1991)
  • [16] Dietrich, Spannagl, Schramm, Et al., The influence of preoperative anticoagulation on heparin response during cardio-pulmonary bypass, J Thorac Cardiovasc Surg, 102, pp. 505-514, (1991)
  • [17] Wilde, Christof, Struck, Pilot study on quality assurance in cardiac surgery, Thorac Cardiovasc Surg, 36, pp. 174-179, (1988)
  • [18] Edmunds, Blood-surface interactions during cardiopulmonary bypass, J Cardiac Surg, 8, pp. 404-410, (1993)
  • [19] Furie, Furie, Molecular and cellular biology of blood coagulation, N Engl J Med, 326, pp. 800-806, (1992)
  • [20] Teufelsbauer, Proidl, Havel, Et al., Early activation of hemostasis during cardiopulmonary bypass: evidence for thrombin mediated hyperfibrinolysis, Thromb Haemostas, 68, pp. 250-252, (1992)
123