Thorac Cardiovasc Surg 2016; 64(07): 589-595
DOI: 10.1055/s-0035-1570119
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Hypercoagulant Abdominal Swabs in Cardiac Surgery: Potential Problems and Background

Stefanie Krajewski
1  Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
,
Teresa Hierlemann
1  Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
,
Bernd Neumann
1  Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
,
Tanja Nathan
1  Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
,
Martin Abel
2  Medical & Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Rengsdorf, Germany
,
Annette Koggel
2  Medical & Regulatory Affairs, Lohmann & Rauscher GmbH & Co KG, Rengsdorf, Germany
,
Christian Schlensak
1  Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
,
Hans Peter Wendel
1  Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
› Author Affiliations
Further Information

Publication History

06 August 2015

16 November 2015

Publication Date:
14 January 2016 (online)

Abstract

Background During cardiac surgery with heart-lung-machine support, abdominal swabs are routinely used to adsorb blood from the operation field. In part, abdominal swabs exhibit procoagulant activity, which is usually considered harmless. However, coagulation induction and abnormal clot formation on the surface of abdominal swabs in the operation field may, if the blood is retransfused into the extracorporeal circuit, lead to severe thromboembolic complications. The aim of the present study was to elucidate the origin of the unexpected blood clotting upon contact with hypercoagulant swabs.

Methods The coagulant properties of three abdominal swabs were characterized using a simple clotting test and human whole blood, which was anticoagulated with different heparin concentrations. Eluates prepared from the abdominal swabs and the color stabilizer polydiallyamine (PDAA) were incubated with blood and blood clotting was investigated. Furthermore, the effects of the abdominal swabs on blood clotting time and on heparin were investigated.

Results Our data show that the three abdominal swabs as well as the respective eluates exhibit distinctive coagulant properties. The abdominal swab with the highest hypercoagulant effect significantly reduced blood clotting time and also led to a reduction in free heparin. PDAA does not induce activation of the coagulation system.

Conclusion The data indicate that the hypercoagulant swab reduces the clotting time and the concentration of free heparin. Abdominal swabs used during complex cardiac surgery with heart-lung-machine support should definitely be tested for their coagulant properties using appropriate tests before clinical applications, as it cannot be specified what leads to their hypercoagulant property.