Hypercoagulant Abdominal Swabs in Cardiac Surgery: Potential Problems and Background

Abstract

Background During cardiac surgery with heart-lung-machine support, abdominal swabs are routinely used to adsorb blood from the operation field. In part, abdominal swabs exhibit procoagulant activity, which is usually considered harmless. However, coagulation induction and abnormal clot formation on the surface of abdominal swabs in the operation field may, if the blood is retransfused into the extracorporeal circuit, lead to severe thromboembolic complications. The aim of the present study was to elucidate the origin of the unexpected blood clotting upon contact with hypercoagulant swabs.

Methods The coagulant properties of three abdominal swabs were characterized using a simple clotting test and human whole blood, which was anticoagulated with different heparin concentrations. Eluates prepared from the abdominal swabs and the color stabilizer polydiallyamine (PDAA) were incubated with blood and blood clotting was investigated. Furthermore, the effects of the abdominal swabs on blood clotting time and on heparin were investigated.

Results Our data show that the three abdominal swabs as well as the respective eluates exhibit distinctive coagulant properties. The abdominal swab with the highest hypercoagulant effect significantly reduced blood clotting time and also led to a reduction in free heparin. PDAA does not induce activation of the coagulation system.

Conclusion The data indicate that the hypercoagulant swab reduces the clotting time and the concentration of free heparin. Abdominal swabs used during complex cardiac surgery with heart-lung-machine support should definitely be tested for their coagulant properties using appropriate tests before clinical applications, as it cannot be specified what leads to their hypercoagulant property.

Keywords

blood - coagulation/anticoagulation - cardiopulmonary bypass - surgery - complications

• References

• 1 Weerasinghe A, Taylor KM. The platelet in cardiopulmonary bypass. Ann Thorac Surg 1998; 66 (6) 2145-2152
• 2 Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med 2004; 30 (10) 1873-1881
• 3 Riess F. Gerinnungsprobleme in der Kardiochirurgie. Intensivmed 2001; 38 (9) 116-122
• 4 Despotis GJ, Gravlee G, Filos K, Levy J. Anticoagulation monitoring during cardiac surgery: a review of current and emerging techniques. Anesthesiology 1999; 91 (4) 1122-1151
• 5 Krajewski S, Nathan T, Neumann B , et al. Simple clotting test to detect procoagulant abdominal swabs. J Mater Sci Mater Med 2015; 26 (2) 106
• 6 Krajewski S, Krauss S, Kurz J, Neumann B, Schlensak C, Wendel HP. Real-time measurement of free thrombin: evaluation of the usability of a new thrombin assay for coagulation monitoring during extracorporeal circulation. Thromb Res 2014; 133 (3) 455-463
• 7 van Harten AE, Scheeren TW, Absalom AR. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia 2012; 67 (3) 280-293
• 8 Hartmann M, Sucker C, Boehm O, Koch A, Loer S, Zacharowski K. Effects of cardiac surgery on hemostasis. Transfus Med Rev 2006; 20 (3) 230-241
• 9 Thiele RH, Raphael J. A 2014 update on coagulation management for cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth 2014; 18 (2) 177-189
• 10 Wendel HP, Philipp A, Weber N, Birnbaum DE, Ziemer G. Oxygenator thrombosis: worst case after development of an abnormal pressure gradient—incidence and pathway. Perfusion 2001; 16 (4) 271-278
• 11 Blauth CI. Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 1995; 59 (5) 1300-1303
• 12 Taylor RL, Borger MA, Weisel RD, Fedorko L, Feindel CM. Cerebral microemboli during cardiopulmonary bypass: increased emboli during perfusionist interventions. Ann Thorac Surg 1999; 68 (1) 89-93
• 13 Sadel SM. Safety and management of perturbations during cardiopulmonary bypass. Cardiopulmonary Bypass Principles and Techniques of Extracorporeal Circulation. New York: Springer; 1995. , pp. 298–308
• 14 Hirsh J, Anand SS, Halperin JL, Fuster V. Mechanism of action and pharmacology of unfractionated heparin. Arterioscler Thromb Vasc Biol 2001; 21 (7) 1094-1096