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The Journal of Cardiovascular Surgery 2000 August;41(4):595-9

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

An analysis of risk factors of perioperative bleeding in surgical repair of abdominal aortic aneurysm

Miyashita T., Ando M., Hanafusa Y., Onishi Y., Kuro M.

From the Department of Anesthesiology and *Cardiovascular Surgery National Cardiovascular Center Suita, Osaka, Japan


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Background. In sur­gi­cal ­repair of abdom­i­nal aor­tic aneu­rysm (AAA), exces­sive bleed­ing ­which caus­es post­op­er­a­tive com­pli­ca­tions is some­times ­observed. To deter­mine the ­risk fac­tors of per­i­op­er­a­tive exces­sive ­blood ­loss, ­this ret­ro­spec­tive ­study was per­formed.
Methods. Design. A ret­ro­spec­tive ­study. Setting. An aca­dem­ic med­i­cal cen­ter. Participants. One hun­dred and for­ty ­patients under­went elec­tive sur­gi­cal ­repair of an abdom­i­nal aor­tic aneu­rysm (AAA) at our insti­tu­tion ­from 1995 ­through 1997. Measurements. The ­present ­study ­includes crit­i­cal ­review of 140 con­sec­u­tive ­charts of ­patients under­go­ing elec­tive sur­gi­cal ­repair of AAA. Preoperative labor­a­to­ry ­data, intra­op­er­a­tive ­data and ­amount of ­blood ­loss to iden­ti­fy ­risk fac­tors of per­i­op­er­a­tive ­blood ­loss. Factors ­which ­were ­found to be sig­nif­i­cant­ly asso­ciat­ed ­with the ­amount of per­i­op­er­a­tive ­blood ­loss ­were pre­op­er­a­tive plas­ma ­fibrin deg­ra­da­tion prod­uct (FDP) lev­el (r=0.445), ­amount of imme­di­ate re-in­fu­sion of ­shed ­blood (r=0.438), and dura­tion of oper­a­tion (r=0.411).
Results. Preoperative fibrino­gen lev­el cor­re­lat­ed ­with per­i­op­er­a­tive ­blood ­loss lit­tle (r=-0.187). Preoperative plate­let ­count or the oth­er coag­u­la­tion pro­file did not ­affect the ­amount of per­i­op­er­a­tive ­blood ­loss. The ­patients ­whose pre­op­er­a­tive FDP ­were ­more ­than 40μg·ml-1 sig­nif­i­cant­ly ­increased the ­risk of exces­sive ­blood ­loss com­pared ­with ­less ­than 40 μg·ml-1.
Conclusions. The sig­nif­i­cant pre­op­er­a­tive ­risk fac­tor of per­i­op­er­a­tive ­blood ­loss was ­only FDP lev­el in ­present ­study. Especially, the ­patients ­whose pre­op­er­a­tive FDP ­were ­more ­than 40 μg·ml-1 ­increased the ­risk of exces­sive ­blood ­loss.

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