Retrospective study: the effect of preoperative heparinization on postoperative platelet count assessed by ACT levels in open-heart surgery

Abstract

Aims: Our study aimed to investigate the effect of activated clotting time (ACT) and hematocrit (HCT) levels on commonly used hematological and coagulation parameters (RDW, PLT, MPW, PT, INR, APTT, CRP) in patients undergoing cardiopulmonary bypass (CPB), and to determine the predictive power of these parameters for ACT. Methods: Pre-and postoperative hematological and coagulation data of patients who underwent open-heart surgery with CPB between January 2024 and June 2025 were retrospectively analyzed. Patients were grouped according to ACT and HCT levels. Intergroup differences were assessed using appropriate parametric or non-parametric tests. Receiver operating characteristic (ROC) analysis and logistic regression were performed to evaluate the predictive value of ACT. Results: No significant differences were observed in most hematological and coagulation parameters according to ACT and HCT levels (p>0.05). Only PRE.RDW and POST.PLT were significantly different according to HCT levels, and only POST.CRP was significant according to ACT levels (p<0.05). ROC analysis indicated that all parameters, including PRE.HCT with the highest AUC (0.63), had poor discriminative ability. Logistic regression analysis demonstrated that POST.MPV, POST.RDW, and POST.PLT could not reliably predict ACT levels. Conclusion: In patients undergoing CPB, changes in ACT and HCT levels were found to have limited effects on hematological and coagulation parameters. The few significant differences observed did not provide strong clinical discrimination, and ROC and regression analyses demonstrated that these parameters are insufficient for predicting ACT levels. Consequently, routine laboratory parameters alone are not reliable for ACT management, highlighting the need for more specific biomarkers.

Keywords

• Cardiopulmonary bypass
• activated clotting time
• hematological parameters
• coagulation tests

Retrospektif çalışma: açık kalp cerrahisi öncesi uygulanan heparinizasyonun ACT düzeyleri aracılığıyla postoperatif trombosit sayısına etkisi

Abstract

Amaç: Çalışmamız, kardiyopulmoner by-pass (KPB) uygulanan hastalarda Aktive Pıhtılaşma Zamanı (ACT) ve Hematokrit (HCT) düzeylerinin, yaygın kullanılan hematolojik ve koagülasyon parametreleri (RDW, PLT, MPW, PT.INR, APTT, CRP) üzerindeki etkisini ve bu parametrelerin ACT prediktif gücünü araştırmayı amaçlamıştır. Yöntemler: Ocak 2024–Haziran 2025 arasında KPB eşliğinde açık kalp cerrahisi uygulanan hastaların pre- ve postoperatif hematolojik ile koagülasyon verileri retrospektif olarak incelendi. Hastalar ACT ve HCT düzeylerine göre gruplandırıldı. Gruplar arası farklar parametrik/non-parametrik uygun testlerle değerlendirildi. ACT’ yi öngörme gücünü belirlemek için ROC analizi ve lojistik regresyon kullanıldı. Bulgular: İncelenen hematolojik ve koagülasyon parametrelerinin çoğunda ACT ve HCT düzeylerine göre anlamlı bir fark saptanmamıştır (p>.05). HCT düzeyine göre yalnızca PRE.RDW ve POST.PLT, ACT düzeyine göre ise yalnızca POST.CRP anlamlı bulunmuştur (p<.05). ROC analizi, en yüksek AUC değerine sahip olan PRE.HCT (AUC: 0.63) dâhil tüm parametrelerin ayırt edicilik düzeyinin zayıf olduğunu göstermiştir. Lojistik regresyon analizinde ise POST.MPW, POST.RDW ve POST.PLT parametrelerinin ACT düzeylerini güvenilir şekilde öngöremediği belirlenmiştir. Sonuç: KPB uygulanan hastalarda ACT ve HCT düzeylerindeki değişikliklerin hematolojik ve koagülasyon parametreleri üzerinde sınırlı etkisi olduğu bulunmuştur. Saptanan birkaç anlamlı fark klinik olarak güçlü bir ayırt edicilik sağlamamış, ROC ve regresyon analizleri de bu parametrelerin ACT düzeylerini öngörmede yetersiz olduğunu göstermiştir. Sonuç olarak, ACT yönetiminde rutin laboratuvar parametreleri tek başına güvenilir değildir ve daha spesifik belirteçlere ihtiyaç vardır.

Keywords

• Kardiyopulmoner Bypass
• Aktive Pıhtılaşma Zamanı
• Hematolojik Parametreler
• Koagülasyon Testleri

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