PubMed · 5826921
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1965-10-23. Defibrination syndrome.. https://pubmed.ncbi.nlm.nih.gov/5826921/
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PURPOSE: Our 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. METHODS: Retrospective 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. RESULTS: Eighty-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). CONCLUSIONS: Pre-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.
The paper deals with specific features of the neonatal coagulation system. The plasma concentration of the majority of coagulation factors is lower in neonates than in adults, whereby near-adult values are achieved for most components by 6 months of life. Bleeding episodes in haemophilic newborns are rare but may be of a profound nature, thus a proper communication between all involved physicians may aid in the management of such patients. On the other hand thromboembolic episodes might complicate neonatal intensive care, in particular in patients with an indwelling central line. Also inherited thrombophilia might contribute to the development of neonatal thrombosis. Prophylaxis and therapy of vitamin K deficiency bleeding are discussed.
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