Acute intracardiac thrombosis and pulmonary thromboembolism after cardiopulmonary bypass: A systematic review of reported cases
Document Type
Journal Article
Publication Date
7-4-2017
Journal
Anesthesia and Analgesia
Volume
126
Issue
2
DOI
10.1213/ANE.0000000000002259
Abstract
Intracardiac thrombosis (ICT) and pulmonary thromboembolism (PE) after cardiopulmonary bypass (CPB) are life-threatening events, but pathological mechanisms are not yet well defined. The aim of this review is to provide an update of case literature of a postbypass hypercoagulable state. Case commonalities among 48 ICT/PE events included congestive heart failure (50%), platelet transfusion (37.5%), CPB duration greater than 3 hours (37.5%), and aortic injury (27.1%). Preexisting thrombophilia was rarely reported, and 16.7% had low activated clotting time, ≤400 seconds during CPB. Mortality rate was very high (85.4%), despite attempted thrombectomy and supportive therapy. Thrombolytic therapy was infrequently used (5 of 48 times), but its efficacy is questionable due to common use of antifibrinolytic therapy (77.1% of cases). Acute ICT/PE events appear to rarely occur, but common features include prolonged CPB, depressed myocardial function, major vascular injury, and hemostatic interventions. Further efforts to elucidate pathomechanisms and optimize anticoagulation during CPB and hemostatic interventions after CPB are warranted.
APA Citation
Williams, B., Wehman, B., Mazzeffi, M., Odonkor, P., Harris, R., Kon, Z., & Tanaka, K. (2017). Acute intracardiac thrombosis and pulmonary thromboembolism after cardiopulmonary bypass: A systematic review of reported cases. Anesthesia and Analgesia, 126 (2). http://dx.doi.org/10.1213/ANE.0000000000002259