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- Title
A comparison of haemostatic biomarkers during low-risk patients undergoing cardiopulmonary bypass using either conventional centrifugal cell salvage or the HemoSep device.
- Authors
Boyle, Gethin; Grehan, Aidan; Kuffel, Agnieszka; Parmar, Kiran; Hunt, Beverley J.; Gibson, Kirsty; Smith, Megan; Chambers, David J.
- Abstract
Background: Cardiac surgery using cardiopulmonary bypass (CPB) is associated with a coagulopathy due to haemodilution, thrombocytopenia and platelet dysfunction and the activation of coagulation and fibrinolysis, despite the use of large doses of unfractionated heparin. Conventional red cell salvage may exacerbate post-operative bleeding as plasma containing haemostatic factors is discarded. We hypothesized that a novel cell salvage device (HemoSep) may attenuate haemostatic changes associated with red cell salvage. We studied haemostatic markers following autologous transfusion from conventional cell salvage or the HemoSep device. Methods: This randomised, controlled trial compared haemostatic markers in patients undergoing coronary artery bypass grafting or aortic valve replacement who received autologous blood returned from cell salvage (control) or HemoSep (study). Blood samples were taken pre-operatively, end of CPB, post-transfusion of salvaged blood and 3 hours post-operatively and analysed for full blood count (FBC), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer and endogenous thrombin potential (ETP). Results: Fifty-four patients were recruited (n=28 control, n=26 study). Processed blood volume for transfusion was significantly (p<0.001) higher in the HemoSep group. In the HemoSep group, the PT was shorter (18.7±0.3 vs 19.9±0.3 sec; p<0.05) post-operatively and the aPTT was longer (48.6±3.8 vs 37.3±1.0 sec; p<0.01) following autologous transfusion. In the control group, D-dimer and ETP levels were higher (1903±424 vs.1088±151; p<0.05 and 739±46 vs. 394±60; p<0.001, respectively) following autologous transfusion. Conclusions: Although centrifuged cell salvage is known to adequately haemoconcentrate and remove unwanted substrates and bacteriological contamination, the process can exacerbate coagulopathy. The HemoSep device demonstrated some increase in haemostatic markers when used in low-risk cardiac surgery patients.
- Subjects
CARDIOPULMONARY bypass; ANALYSIS of variance; BIOMARKERS; BLOOD testing; AUTOTRANSFUSION of blood; BLOOD cell count; CENTRIFUGATION; CARDIAC patients; HEMOSTASIS; RESEARCH funding; STATISTICS; T-test (Statistics); DATA analysis; RANDOMIZED controlled trials; FIBRIN fibrinogen degradation products; DATA analysis software; DESCRIPTIVE statistics; OPERATIVE blood salvage; EQUIPMENT &; supplies
- Publication
Perfusion, 2019, Vol 34, Issue 1, p76
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/0267659118789051