Evidence map›Paper›PMID 34939141›Full record

Observational studyCanadian journal of anaesthesia = Journal canadien d'anesthesie2022

The association of thrombin generation with bleeding outcomes in cardiac surgery: a prospective observational study.

Justyna Bartoszko, Han Li, John Fitzgerald, Loretta T S Ho, Cyril Serrick, Walter H A Kahr, Peter L Gross, Keyvan Karkouti

Open access · bronzeAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.0field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 13 citations in OpenAlex.

  1. Observational
  2. Article
  3. Assessment of Rotational Thromboelastometry and Thrombin Generation Assay to Identify Risk of High Blood Loss and Re-Operation After Cardiac Surgery.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

Justyna BartoszkoDepartment of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada. justyna.bartoszko@uhn.ca.ORCID http://orcid.org/0000-0002-0738-0451
Han LiPerfusion Services, University Health Network, Toronto, ON, Canada.
John FitzgeraldDepartment of Anaesthesia and Intensive Care, Beaumont Hospital, Dublin, Ireland.
Loretta T S HoDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Cyril SerrickPerfusion Services, University Health Network, Toronto, ON, Canada.
Walter H A KahrDepartments of Paediatrics and Biochemistry, University of Toronto, Toronto, ON, Canada.
Peter L GrossDivision of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Keyvan KarkoutiDepartment of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada.
University Health Network · CAUniversity of Toronto · CABeaumont Hospital · IEMcMaster University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiac surgery with cardiopulmonary bypass (CPB) is associated with coagulopathic bleeding. Impaired thrombin generation may be an important cause of coagulopathic bleeding but is poorly measured by existing hemostatic assays. We examined thrombin generation during cardiac surgery, using calibrated automated thrombography, and its association with bleeding outcomes.

methodsWe conducted a prospective observational study in 100 patients undergoing cardiac surgery with CPB. Calibrated automated thrombography parameters were expressed as a ratio of post-CPB values divided by pre-CPB values. The association of thrombin generation parameters for bleeding outcomes was compared with conventional tests of hemostasis, and the outcomes of patients with the most severe post-CPB impairment in thrombin generation (≥ 80% drop from baseline) were compared with the rest of the cohort.

resultsAll 100 patients were included in the final analysis, with a mean age of 63 (12) yr, 31 (31%) female, and 94 (94%) undergoing bypass and/or valve surgery. Post-CPB, peak thrombin decreased by a median of 73% (interquartile range [IQR], 49-91%) (P < 0.001) and total thrombin generation, expressed as the endogenous thrombin potential (ETP), decreased 56% [IQR, 30-83%] (P < 0.001). In patients with ≥ 80% decrease in ETP, 21% required re-exploration for bleeding compared with 7% in the rest of the cohort (P = 0.04), and 48% required medical or surgical treatment for hemostasis compared with 27% in the rest of the cohort (P = 0.04).

conclusionsThrombin generation is significantly impaired by CPB and associated with higher bleeding severity. Clinical studies aimed at the identification and treatment of patients with impaired thrombin generation are warranted.

Indexed as

Cardiac Surgical ProceduresThrombinBlood Coagulation TestsCardiopulmonary BypassFemaleHemostasisHumansMiddle AgedThrombinBlood coagulation disordersCardiac surgical proceduresHemostasisPerioperative careThrombin

Identifiers

PMID34939141
OpenAlexW4200504405

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.