Violation of Coagulation and Hemostasis during Open Cardiac Surgery
Introduction. Postoperative bleeding is one of the most common complications in cardiac surgery. The “surgical” cause of bleeding is found in 50% of patients who underwent reoperation for bleeding. In the rest of the patients, the cause is multifactorial and it is probably related to the peculiarities of changes in hemostasis and homeostasis during the primary operation. Purpose. The purpose of the study is to determine the impact of CPB on hemostasis disorders and their contribution in blood loss volume after the open heart surgery. Materials and methods. 40 adult patients (over 18 years old) who underwent open-heart surgery (CABG, CABG combined with valve repair, valve repair surgery) at the Republican Clinical Medical Center from January 2018 to May 2021 were enrolled in the study. Liver dysfunction (serum alanine aminotransferase elevation by more than 2 times from the upper limit of the norm) was used as exclusion criteria. Comprehensive analysis of hemostasis was conducted at three points (before CPB, during CPB, and on the Day 1 after surgery). To understand the characteristics of coagulation we determined the activity of coagulation factors (II, V, VII, VIII, IX, X, XI, XII, XIII). Results. It was found that activity of the II, V, VII, X, XIII factors of plasma hemostasis significantly decreased during CPB and restored on the postoperative Day 1. Activity of the factors II, V, VII, X, XII, XIII restored, but did not achieved the basic levels. Activity of the factors II, V, VII was lower than 50% during CPB. Factor VIII activity significantly influenced the blood loss volume in a day after surgery. Conclusion. Understanding the key mechanisms and causes of coagulation changes during CPB can provide additional help leading to effective use of technical and pharmaceutical options that are currently available. It decreases the risk of complications associated with postoperative bleeding.