Hemorrhage Related Reexploration following Open Heart Surgery: The Impact of Pre-Operative and Post-Operative Coagulation Testing

Abstract

Purpose: Our objective was to determine the association of pre-operative and post-operative coagulation testing abnormalities with the cause of post-operative bleeding requiring re-exploration following cardiac surgery. Methods: Retrospective chart review of post-operative bleeding and the incidence of re-exploration for hemorrhage in 2263 adult patients undergoing elective and emergency open heart surgery which included coronary artery bypass, valvular, and combined valve coronary procedures. Results: Eighty-two patients (3.6%) required re-exploration. Sixty-six percent had surgical bleeding; the remaining 34% were coagulopathic (no surgical site found). The pre-operative PT and ACT were significantly elevated in coagulopathic patients ( P<0.005). Post-operative ACT, PT, and APTT were increased and fibrinogen levels were decreased in coagulopathic patients ( P<0.05). Conclusions: Pre-operative testing (ACT, PT) weakly correlated with post-operative coagulopathy. Post-operative coagulation abnormalities were identified with high risk ratios and good diagnostic accuracy when using testing cut-off values to assist in surgical decision making.