• Timothy S Hall, Jean C Sines, and Alan J Spotnitz.
• Department of Cardiothoracic Surgery, University of California, PO Box 0118, M593, San Francisco, CA 94143, USA. tshall@itsa.ucsf.edu
• Cardiovasc Surg. 2002 Apr 1; 10 (2): 146-53.

PurposeOur 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.MethodsRetrospective 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.ResultsEighty-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).ConclusionsPre-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.

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