Relationship of preoperative FⅩⅢ activity and postoperative chest tube drainage to transfusion requirements in cardiopulmonary bypass coronary artery bypass grafting

Ge Fei; Song Shuang; Xu Xu; Kou Ping

doi:10.13498/j.cnki.chin.j.ecc.2025.04.06

Abstract：Objective To investigate the relationship between preoperative coagulation factor ⅩⅢ(FⅩⅢ)activity,postoperative chest tube drainage(CTD)and transfusion requirements for coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB).Methods A retrospective study was conducted from March 2022 to March 2024,which included 73 patients who underwent CPB CABG at our cardiovascular surgery center.Patients with transfusion requirements were transfused postoperatively according to transfusion guidelines.Preoperative FⅩⅢ activity was assayed by using a color-emitting substrate method,and the CTD volume in the first 48 h postoperatively was recorded.Results Of the 73 patients,a total of 50(68.49%)received postoperative blood transfusions.Of these,36(49.32%)were transfused with packed red blood cells(PRBCs);13(17.81%)were transfused with platelets(PLTs);and 42(57.53%)were transfused with fresh frozen plasma(FFP).Compared with patients who were transfused postoperatively,those who were not transfused had significantly lower ICU length of stay,postoperative intubation time,48 h postoperative CTD relative volume(total volume/body weight),and intraoperative blood loss(P<0.05);whereas central venous pressure(CVP)and preoperative FⅩⅢ activity level were significantly higher(P<0.05).Multifactorial logistic modeling showed that preoperative FⅩⅢ activity<96.81%(median value)and 48 h postoperative CTD relative volume≥16.70 ml/kg(median value)in the first 48 h postoperatively were independent risk factors affecting postoperative blood transfusion(P<0.05).The area under the curve(AUC)of preoperative FⅩⅢ activity and the 48 h postoperative CTD relative volume predicting postoperative blood transfusion was 0.731(95%CI:0.619～0.844)and 0.799(95%CI:0.688～0.911),respectively,and the AUC was increased to 0.879(95%CI:0.785～0.973)for the combination of the two predicting postoperative blood transfusion.Spearman's correlation showed that the 48 h postoperative CTD relative volume was positively correlated with the total amount of PRBC transfusion(Rho=0.529)and FFP transfusion(Rho=0.3779),P<0.05.Conclusion The results of this study demonstrate that although preoperative FⅩⅢ activity is not related to the amount of postoperative CTD,patients with low preoperative FⅩⅢ activity and a relatively high amount of postoperative CTD are more likely to receive postoperative transfusions.