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The haematocrit - an important factor causing impaired haemostasis in patients with cyanotic congenital heart disease

Jensen, A. S.; Johansson, P. I.; Idorn, L.; Sorensen, K. E.; Thilén, Ulf LU ; Nagy, E.; Furenas, E. and Sondergaard, L. (2013) In International Journal of Cardiology 167(4). p.1317-1321
Abstract
Background: Patients with cyanotic congenital heart disease(CCHD) have haemostatic abnormalities, which result in an increased risk of bleeding. The cause is unknown, but recent studies have indicated that an elevated haematocrit, which is present in cyanotic patients, could be an important factor. The aim of this study was to characterize the haemostatic profile, examine how changes in haematocrit affect the haemostatic profile, and whether a haematocrit reduction could terminate bleeding in CCHD patients. Methods: This was a prospective, multicenter study. The haemostatic profile consisting of haematocrit, platelet count and thrombelastography(TEG) was characterized in ninety-eight CCHD patients. To evaluate the influence of haematocrit... (More)
Background: Patients with cyanotic congenital heart disease(CCHD) have haemostatic abnormalities, which result in an increased risk of bleeding. The cause is unknown, but recent studies have indicated that an elevated haematocrit, which is present in cyanotic patients, could be an important factor. The aim of this study was to characterize the haemostatic profile, examine how changes in haematocrit affect the haemostatic profile, and whether a haematocrit reduction could terminate bleeding in CCHD patients. Methods: This was a prospective, multicenter study. The haemostatic profile consisting of haematocrit, platelet count and thrombelastography(TEG) was characterized in ninety-eight CCHD patients. To evaluate the influence of haematocrit on the haemostatic profile, 21 of the patients underwent phlebotomy and 16 patients received treatment with an iron supplement. Furthermore ten patients with haemoptysis underwent phlebotomy. The haemostatic profile was reevaluated after interventions. Results: TEG revealed that patients with CCHD and elevated haematocrit were hypocoagulable due to reduced clot formation and strength. Furthermore a positive correlation between elevated haematocrit and hypocoagulability was present. Interventions such as phlebotomy and treatment with supplemental iron causing significant haematocrit changes confirmed the correlation between haematocrit and the haemostatic profile. Finally a haematocrit reduction by phlebotomy successfully terminated haemoptysis in ten CCHD patients. Conclusion: Patients with CCHD and elevated haematocrit are hypocoagulable. The hypocoagulable haemostatic profile is positively correlated to increasing haematocrit. An intervention, which increases or decreases haematocrit, changes the haemostatic profile. A haematocrit reduction seems to improve the haemostatic profile, and may thereby terminate bleeding. However, these results warrant further studies. (C) 2012 Elsevier Ireland Ltd. All rights reserved. (Less)
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author
organization
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type
Contribution to journal
publication status
published
subject
keywords
Cyanotic congenital heart disease, Haematocrit, Thrombelastography, Haemostasis, Haemoptysis
in
International Journal of Cardiology
volume
167
issue
4
pages
1317 - 1321
publisher
Elsevier
external identifiers
  • wos:000323566800048
  • scopus:84881476952
ISSN
0167-5273
DOI
10.1016/j.ijcard.2012.03.181
language
English
LU publication?
yes
id
dbcd05ce-5a72-4264-86be-1c8ac8310f5e (old id 4063395)
date added to LUP
2014-03-03 08:11:20
date last changed
2019-04-23 01:16:30
@article{dbcd05ce-5a72-4264-86be-1c8ac8310f5e,
  abstract     = {Background: Patients with cyanotic congenital heart disease(CCHD) have haemostatic abnormalities, which result in an increased risk of bleeding. The cause is unknown, but recent studies have indicated that an elevated haematocrit, which is present in cyanotic patients, could be an important factor. The aim of this study was to characterize the haemostatic profile, examine how changes in haematocrit affect the haemostatic profile, and whether a haematocrit reduction could terminate bleeding in CCHD patients. Methods: This was a prospective, multicenter study. The haemostatic profile consisting of haematocrit, platelet count and thrombelastography(TEG) was characterized in ninety-eight CCHD patients. To evaluate the influence of haematocrit on the haemostatic profile, 21 of the patients underwent phlebotomy and 16 patients received treatment with an iron supplement. Furthermore ten patients with haemoptysis underwent phlebotomy. The haemostatic profile was reevaluated after interventions. Results: TEG revealed that patients with CCHD and elevated haematocrit were hypocoagulable due to reduced clot formation and strength. Furthermore a positive correlation between elevated haematocrit and hypocoagulability was present. Interventions such as phlebotomy and treatment with supplemental iron causing significant haematocrit changes confirmed the correlation between haematocrit and the haemostatic profile. Finally a haematocrit reduction by phlebotomy successfully terminated haemoptysis in ten CCHD patients. Conclusion: Patients with CCHD and elevated haematocrit are hypocoagulable. The hypocoagulable haemostatic profile is positively correlated to increasing haematocrit. An intervention, which increases or decreases haematocrit, changes the haemostatic profile. A haematocrit reduction seems to improve the haemostatic profile, and may thereby terminate bleeding. However, these results warrant further studies. (C) 2012 Elsevier Ireland Ltd. All rights reserved.},
  author       = {Jensen, A. S. and Johansson, P. I. and Idorn, L. and Sorensen, K. E. and Thilén, Ulf and Nagy, E. and Furenas, E. and Sondergaard, L.},
  issn         = {0167-5273},
  keyword      = {Cyanotic congenital heart disease,Haematocrit,Thrombelastography,Haemostasis,Haemoptysis},
  language     = {eng},
  number       = {4},
  pages        = {1317--1321},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {The haematocrit - an important factor causing impaired haemostasis in patients with cyanotic congenital heart disease},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2012.03.181},
  volume       = {167},
  year         = {2013},
}