Risks associated with bleeding and transfusion: rationale for the optimal management of bleeding after cardiac surgery

Gelatin and the risk of bleeding after cardiac surgery

BACKGROUND

Gelatins has been used in cardiac surgery because of their ability to preserve intravascular volume better than crystalloids. Unfortunately, gelatin has been associated with impaired coagulation and hemostasis, that may cause increased bleeding. We investigated whether the administration of gelatin increases postoperative bleeding after cardiac surgery.

METHODS

Retrospective, observational single-center cohort study in the intensive care unit of a tertiary teaching hospital. Postoperative bleeding, chest tube drainage volume and consumption of blood products were compared between groups.

RESULTS

Cohort included 3067 consecutive patients who underwent cardiac surgery. First 1698 patients received gelatin (gelatin group), and 1369 patients did not (crystalloid group). The characteristics of the patients in the gelatin and crystalloid groups were comparable. Postoperative chest tube drainage was 18% (95% CI 11%-20%) greater during the first 12 hours (P < .001) and 15% (95% CI 7%-17%) greater during the first 24 hours (P < .001) in the gelatin group compared to the crystalloid group. Severe and massive postoperative bleeding was more common in the gelatin group compared to the crystalloid group (21% vs 16%, P < .001). Patients in the gelatin group received red blood cells (40% vs 20%, P < .001) and platelets (12% vs 8%, P < .001) more frequently than patients in the crystalloid group. However, the number of administered fresh-frozen plasma transfusions did not differ between the groups.

CONCLUSION

Gelatin may increase postoperative bleeding and the need for blood product transfusions after cardiac surgery.