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PEGASUS Research Projects
Postoperative Bleeding
A common, significant problem for cardiac surgery patients is postoperative bleeding. Patients who suffer such events can have increased rates of further medical problems and even death.
Currently, doctors predict post-operative bleeding on factors such as weight, size and blood count. During surgery, they look at the number of vessels being bypassed, the degree of atherosclerotic disease and the use of the heart-lung bypass machine. However, these factors are not always successful.
The presence of specific variants of genes that control clotting and the contractility of blood vessels can double the ability of doctors to predict those at greatest risk of bleeding after surgery.
One PEGASUS study looked at 780 patients undergoing aortocoronary surgery with cardiopulmonary bypass. 19 polymorphisms from 13 candidate genes were examined. It was found that 7 SNPs are associated with increased bleeding after surgery (12 hr CT drainage).
- GPIaIIa -52C/T & 807C/T
- GPIba 524C/T
- Tissue factor -603A/G
- Prothrombin 20210G/A
- Tissue factor pathway inhibitor -399C/T
- Angiotensin converting enzyme (ACE) del/ins
It was found that platelet activation and thrombin generation (prothromnotic combinations) enhance 12 hour CT drainage and ACE deletion decreases postoperative CT drainage.
While multiples single gene analysis is limited, controlling for multiple comparisons is imperative. Even exploratory analysis adds new information as new mechanisms are inferred. This is a starting point for prospective studies. Adding genetic information should increase the ability to predict who is at greatest risk of bleeding.
Welsby IJ et al.,J Thromb Haemost 2005;3(6):1206-12
Welsby IJ et al.,J Thromb Haemost 2005;3(6):1206-12
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