Roles of coagulation factor Ⅻ and factor ⅩⅢ during perioperative period of aortic dissection surgery

Gong Ming; Li Jiachen; Guan Xinliang; Jiang Wenjian; Li Haiyang; Wang Xiaolong; Liu Yuyong; Lan Feng; Zhang Hongjia

doi:10.3760/j.issn.1673-4777.2019.06.011

Abstract：Objective To explore the changes of coagulation factor Ⅻ and factor ⅩⅢ during perioperative period of aortic dissection surgery and the effect on secondary thoracotomy.Methods Eighty-eight patients with Stanford type A aortic dissection undergoing moderate hypothermic circulatory arrest surgery in Beijing Anzhen Hospital,Capital Medical University were enrolled from January 2014 to September 2015;the patients were divided into secondary thoracotomy group(10 cases) and non-secondary thoracotomy group (78 cases).Coagulation factor Ⅻ and activated factor Ⅻ,factor Ⅶ and activated factor Ⅶ,factor ⅩⅢ and activated factor ⅩⅢ,hemoglobin and platelet count were detected after anesthesia induction(t1),at the lowest temperature(t2) and after recovery to 36 ℃ (t3) during circulatory arrest,4 h(t4) and 24 h(t5) after surgery.Relevant factors of secondary thoracotomy due to coagulation disorder were analyzed.Results Coagulation factor Ⅻ significantly decreased during t2-t4 compared to that at t1 (P ＜ 0.001) and recovered to the initial level at t5 (P =0.065).Activated factor ⅩⅫ and activated factor ⅩⅢ significantly increased during t1-t5 (P ＜ 0.05).Coagulation factor ⅩⅢ significantly decreased during t2-t5 (P ＜ 0.05).Coagulation factor Ⅶ significantly decreased at t2,t3 and increased at t4,t5 (all P ＜ 0.05).Intraoperative blood loss,postoperative drainage volume,transfusion volumes of suspended red blood cells,refrigerated plasma and fibrinogen in secondary thoracotomy group were significantly higher than those in non-secondary thoracotomy group[1 700(1 375,2 000)ml vs 1 250(1 000,1 600)ml;4 250(2 533,7 060)ml vs 2 170(1 230,3 555) ml;2 700(1 125,3 825)ml vs 675(600,1 424)ml;1 200(400,1 550)ml vs 400(50,800)ml;2.00(2.00,2.88)g vs 2.00(1.00,2.00) g];platelet count at t2 in secondary thoracotomy group was significantly lower than that in non-secondary thoracotomy group [(61 ± 28) × 109/L vs (72 ± 39) × 109/L] (all P ＜ 0.05).With adjustments of body mass,cardiopulmonary bypass time,operation time,circulatory arrest time,preoperative platelet and hemoglobin levels,multivariable logistic regression analysis suggested that coagulation factor Ⅻ level at t2 was an independent risk factor of reoperation due to coagulation disorder(odds ratio =1.342,95％ confidence interval:1.058-1.570,P =0.012).Conclusions As the initiator of intrinsic pathway,coagulation factor Ⅻ plays an important role during the perioperative period of aortic dissection surgery;the level of factor Ⅻ during hypothermic circulatory arrest may be an independent risk factor of reoperation due to coagulopathy.Coagulation factor ⅩⅢ is an important element in the common coagulation pathway and partly regulates the function of fibrinogen by a feedback mechanism.