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FIBRINOLYSIS PHENOTYPES DIFFER AMONGST CARDIAC SURGERY PATIENTS: ANTIFIBRINOLYTIC THERAPY FOR ALL?
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  • Matthew Sussman,
  • Eva Urrechaga,
  • Alessia Cioci,
  • Rahul Iyengar,
  • Tyler Herrington,
  • Emily Ryon,
  • Nick Namias,
  • david galbut,
  • Tomas Salerno,
  • Kenneth Proctor
Matthew Sussman
University of Miami Miller School of Medicine
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Eva Urrechaga
University of Miami Miller School of Medicine
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Alessia Cioci
University of Miami Miller School of Medicine
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Rahul Iyengar
University of Miami Miller School of Medicine
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Tyler Herrington
University of Miami Miller School of Medicine
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Emily Ryon
University of Miami Miller School of Medicine
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Nick Namias
University of Miami Miller School of Medicine
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david galbut
University of Miami Miller School of Medicine
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Tomas Salerno
university of miami miller school of medicine and jackson memorial hospital
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Kenneth Proctor
University of Miami Miller School of Medicine
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Abstract

The recognition of fibrinolysis phenotypes in trauma patients has led to a reevaluation of antifibrinolytic therapy (AF). Many cardiac patients also receive AF, however the distribution of fibrinolytic phenotypes in that population is unknown. The purpose of this study was to fill that gap. Methods: Data were retrospectively reviewed from 78 cardiac surgery patients. Phenotypes were defined as hypofibrinolytic (LY30 <0.8%), physiologic (LY30 0.8-3.0%) and hyperfibrinolytic (LY30 >3%). Continuous variables were expressed as M ± SD or median (interquartile range). Results: The study population was 65±10 yrs old, 74% male, average body mass index of 29±5 kg/m2. Fibrinolytic phenotypes were distributed as physiologic=45%, hypo=32% and hyper = 23%. There was no obvious effect of age, gender, race, or ethnicity on the distribution of fibrinolysis phenotypes; 47% received AF. The time with chest tube during post-operative recovery was longer in those who received AF (4[3,5] days) vs no AF (3[2,4] days), P=0.037). All cause morbidity occurred in 51% of patients who received AF vs 25% with no AF (p=0.017). However, with AF vs no AF, apparent differences in median chest tube output (1379 vs 820ml, p=0.075), hospital LOS (13 vs 10 days, P=0.873), estimated blood loss (1100 vs 775 ml, P=0.127), units of transfused RBCs (4 vs 2], P=0.152) or all-cause mortality (5.4% [2/37] vs 10% [4/41], P=0.518) were not statistically significant. Conclusion: This is the first description of three distinctly different fibrinolytic phenotypes in cardiac surgery patients. In this population, the use of AF was associated with increased morbidity.

Peer review status:Published

26 Aug 2020Submitted to Journal of Cardiac Surgery
27 Aug 2020Assigned to Editor
27 Aug 2020Submission Checks Completed
Oct 2019Published in Journal of the American College of Surgeons volume 229 issue 4 on pages S44-S45. 10.1016/j.jamcollsurg.2019.08.111