Studies on the Coagulation of the Blood in Patients Treated with Extra-Corporeal Circulation

Conclusions and summary

An extensive investigation of the coagulation mechanism was performed in 21 patients suffering from a congenital heart failure and exposed to surgical treatment with the aid of extra-corporeal circulation. The results have been discussed and suggestions given for the preoperative and postoperative mode of investigation in future. Only three factors may be considered a possible contraindication for the operation, namely

1. a persistent and marked thrombocytopenia,

2. fibrinogenopenia and

3. a high degree of fibrinolysis.

Before a final decision to operate is taken an attempt should be made to restore the impaired coagulation mechanism. The necessity of a preoperative analysis and a close cooperation between the surgeon and the coagulationist before, during and after the operation have been stressed.

• References

• Allen J. G, Moulder P. V, Elghammer R. E, Grossman B. J, McKeen G. L, Sanderson M. H, Egner W, Crosbie J. M. A protamine titration as an indication of a clotting defect in certain hemorrhagic states. J. Lab. clin. Med. 34: 473 1949;
• Astrup T, Müllertz S. The fibrin plate method for estimating fibrinolytic activity. Arch. Biochem. and Biophys. 40: 346 1952;
• Bachmann F, Duckert F, Koller F. The Stuart-Prower factor assay and its clinical significance. Thromb. Diath. haem. 02: 24 1958;
• Blombäck B, Blombäck M. Purification of human and bovine fibrinogen. Ark. f. Kemi. 10: 415 1956;
• Blombäck M, Blombäck B, Wallen P. Determination du taux de l’héparine dans le sang en cas de circulation extracorporelle au cours de la chirurgie cardiaque. Rev. Hémat. 10: 45 1955;
• Bounameaux Y. Dosage du factor VIII en un temps. Acta haemat. 17: 355 1957;
• Brown I. W, Smith W. W. Hematologic problems associated with the use of extracorporeal circulation for cardiovascular surgery. Ann. intern. Med. 49: 1035 1958;
• Bruijne de J. I, van Creveld S, Hoo LiemKhe. Thrombocytopenia after replacement transfusion. “Neo-Natal Studies”. 05: 109 1956;
• Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta haemat. 17: 237 1957;
• Van Creveld S, Paulssen M. M. P. Een nieuwe methode om met behulp van heparine de functie der bloedplaatjes bij verschillende hemorrhagische toestanden te beoordelen, Ned. T. Geneesk. 95: 1971 1951;
• Dausset J, Bergerot-Blondel Y, Colin M. Accelaration of fibrinolysis of blood-clot by dilution with saline and human serum. Lancet 02: 123 1956;
• Holemans R. Overzicht van het bloedstollingsprobleem bij extracorporeale circulatie met behulp van een hart-long machine. Belg. T. Geneesk. 16: 371 1960;
• Kaulla von K. N, Swan H, von Kaulla E. Beobachtungen an Gerinnung und Fibrinolyse während chirurgischer Eingriffe am menschlichen Herzen in Unterkühlung oder mittels extrakorporealen Kreislaufes. Klin. Wschr. 36: 1050 1958;
• Kettenborg H. K, de Vries S. I, van der Pol E. T. Modifications in the behaviour of coagulation factors during storage of blood and its importance for bloodtransfusions. Rev. beige Path. Med. exp. 24: 136 1955;
• Krevans J. R, Jackson D. P. Hemorrhagic disorder following massive whole blood transfusion. J. A. M. A. 150: 171 1955;
• Langdell R. D, Wagner R. H, Brinkhous K. M. Effect of antihemophilic factor on one-stage clotting tests: A presumptive test for hemophilia and simple one-stage antihemophilic factor assay procedure. J. Lab. clin. Med. 41: 637 1953;
• Leikin S, Bessman S. P. The effects of various EDTA complexes on coagulation. Blood. 11: 916 1956;
• Nilsson I. M, Swedberg J. Coagulation studies in cardiac surgery with extracorporeal circulation using a Bubble-oxygenator. Act. chir. scand. 117: 47 1959;
• Nilsson I. M, Sjoerdsma A, Waldenstrom J. Antifibrinolytic activity and metabolism of å-aminocaproic acid in man. Lancet. 01: 1322 1960;
• Penick G. D, Averette H. E, Peters R. M, Brinkhous K. M. The hemorrhagic syndrome complicating extracorporeal shunting of blood: an experimental study of its pathogenesis. Thromb. Diath. haem. 02: 218 1958;
• Perkins H. A, Osborn J. J, Gerbode F. (1) The management of abnormal bleeding following extracorporeal circulation. Ann. intern. Med. 51: 658 (1959); (2) The effect of heparin on the platelet count in vitro. Amer. J. clin. Path. 30: 397 1958;
• Rothnie N. G, Kinmoth J. B. Bleeding after perfusion for open heart surgery. Importance of unneutralized heparin and its proper correction. Brit. med. J. 01: 73 1960;
• Stewart J. W, Sturridge M. F. Haemolysis caused by tubing in extracorporeal circulation. Lancet 01: 340 1959;
• Triantaphyllopoulos D. C, Quick A. J, Greenwalt T. J. Action of disodiumethylenediamine tetracetate on blood coagulation. Blood 10: 534 1955;
• Vries de S. I, van Daelen C. C. Heparinoide stoffen I. De waarde van de protaminesulfaat-titratie volgens Allen als routinemethode bij bestraalde personen. Ned. T. Geneesk. 98: 3051 1954;
• Vries de S. I, Bosman-Schavinga M. T. Simplified cross-matching tests in large blood transfusions. Acta chir. Neerl. 11: 399 1959;
• Vries de S. I, Bosman M. T, Smiers C. M. T. Studies on coagulation factors in stored blood. Proc. Vllth congr. Int. Soc. Blood Transfusion, Rome. 780 1958;
• Wartelle O. Preparation d’un réactif artificiel permettant de doser le facteur antihémophilique B. (P. T. C., Christmas factor). Rev. Hémat. 13: 100 1958;
• Winterstein A. Heparin. Bibi. Haemat. XI: 35 1960;
• Wright T. A, Darte J, Mustard W. T. Postoperative bleeding after extracorporeal circulation. Canad. J. Surg. 02: 142 1959;
• Wulff H. B, Nilsson I. M, Swedberg J. Bekämpfung der postoperativen Blutungsgefahr bei Anwendung einer Herz-Lungen-Maschine (Bubble-oxygenator-Prinzip). Thoraxchirurgie. 07: 140 1959;