Objective: Nowadays, the coagulation status of the cardiac
surgical patient is monitored using standard laboratory parameters.
However, these tests involve long turnaround times, a critical
limitation in settings where the patient’s coagulation status can change
very quickly. The aim of the present study is to describe, through
serial blood controls, traditional tests and Point Of Care (POC), the
coagulation status of patients undergoing cardiopulmonary bypass (CPB).
Design: Observational study. Setting: Azienda Ospedaliero
Universitaria Città della Salute e della Scienza di Torino, University
of Turin, Italy. Partecipants: We enrolled 29 patients undergoing
cardiopulmonary bypass for cardiac surgery at the ‘Città della Salute e
della Scienza’ University Hospital in Turin between March and June
2021. Interventions: In all patients two series of blood samples
were performed at T1 (before the start of CPB, after sternum opening,
before UFH administration) and at T2 (after the end of CPB, after
protamine administration and before any blood component transfusions).
Laboratory tests included blood count, INR, aPTT, Fibrinogen and
functional assay of coagulation factors (AT III, factors II, V, VII,
VIII, IX, X, XI, XII, proteins C and S). An additional sample was
obtained (both at T1 and T2) for ROTEM analysis. Measurements and
Main results: Between the beginning and the end of the bypass
we observed a significant decrease in coagulation factors II, X, XI,
XII, protein C and S with an average percentage decrease of 32.58%,
34.11%, 36.69 %, 47.45%, 33.65% and 30.20%, respectively.
Regarding viscoelastic parameters, we recorded a median increase of
22.64% of CT in Intem during CPB, with a reduction in MCF in Fibtem of
16.66%, as well as platelet contribution (MCF Extem-Fibtem), which was
reduced by 7.69%. Conclusions: CPB-induced coagulopathy involve
dilution, activation and consumption of all components of haemostasis,
together with the need for profound anticoagulation. Our data seem to
confirm the important reduction of all coagulation factors and
platelets, together with a consensual change in traditional laboratory
and viscoelastic parameters.