Meta-analysis of the effect of cardiopulmonary bypass on thrombus elasticity index in patients undergoing cardiac surgery

Guo Shiqi; Zhang Yulin; Guo Yuhao

doi:10.3969/j.issn.1674-4055.2019.11.03

Abstract：systematic evaluate of the effect of cardiopulmonary bypass on thromboelastogram indicators in patients undergoing cardiac surgery. Methods Databases including PubMed, The Cochrane Library, Ovid, Embase, China Biology Medicine disc, and China National Knowledge Infrastructure were searched to collect pertinent studies about the outcome of thromboelastogram before and after cardiopulmonary bypass in patients undergoing cardiac surgery from inception to July 31th 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 and Stata 14 software. Result Ten retrospective studies met the inclusion criteria and 342 patients were included in the final analysis. Pooled analysis showed that platelet (MA) damage is most severe before and after cardiopulmonary bypass (SMD=-0.88, 95%CI: -1.10~-0.65, P<0.00001). Clotting factor (R) damage is also serious (SMD=0.74, 95%CI: 0.33~1.16, P=0.0005). Fibrinogen (K and Angle) damage is minimal (K: SMD=0.61, 95%CI: 0.38~0.85, P<0.00001; Angle: SMD=-0.41, 95%CI: -0.59~-0.23, P<0.0001). Conclusions This meta-analysis shows that cardiopulmonary bypass caused great damage to the coagulation function of patients undergoing cardiac surgery, in which platelets ranked first, coagulation factors took second place, and fibrinogen was the last. The measurement error of R is large and the reference value is the smallest. The reference value of the other three items was not different. Both K and Angle represent fibrinogen, but Angle is more valuable than K.