• Michel Kindo, Tam Hoang Minh, Sébastien Gerelli, Nicolas Meyer, Mickaël Schaeffer, Stéphanie Perrier, Jonathan Bentz, Tarek Announe, Arnaud Mommerot, Olivier Collange, Sandrine Marguerite, Adrien Thibaud, Hubert Gros, Philippe Billaud, and Jean-Philippe Mazzucotelli.
• Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France. Electronic address: michel.kindo@chru-strasbourg.fr.
• Thromb. Res. 2014 Aug 1;134(2):346-53.

BackgroundObesity is suggested to reduce postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) but perioperative hemostasis variations have not been studied. Therefore, we investigated the effects of severe obesity (body mass index [BMI] ≥35kg/m(2)) on chest tube output (CTO) and hemostasis in patients undergoing cardiac surgery with CPB.Materials And MethodsWe prospectively investigated 2799 consecutive patients who underwent coronary and/or valve surgery using CPB between 2008 and 2012. 204 patients (7.3%) presented a severe obesity.ResultsIn the severe obesity group, the 6-h and 24-h CTO were significantly reduced by -21.8% and -14.8% respectively (P<0.0001) compared with the control group. A significant reduction of the mean number of red blood cell units transfused at 24h was observed in the severe obesity groups (P=0.01). On admission to the intensive care unit, a significant increase of platelet count (+9.2%; P<0.0001), fibrinogen level (+12.2%; P<0.0001) and prothrombin time (+4.1%; P<0.01) and a significant decrease of the activated partial thromboplastin time (-4.2%; P<0.01) were observed in the severe obesity group compared with the control group. In multivariate analysis, severe obesity was significantly associated to a decreased risk of excessive bleeding (24-h CTO >90th percentile; Odds ratio: 0.37, 95% CI: 0.17 to 0.82). No significant differences were observed regarding postoperative thromboembolic events between the two groups.ConclusionsSevere obesity is associated with a prothrombotic postoperative state that leads to a reduction of postoperative blood loss in patients undergoing cardiac surgery with CPB.Copyright © 2014 Elsevier Ltd. All rights reserved.

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