We read, with great interest, the ‘Letter to the Editor’ by Cerit1 concerning our work recently published in the European Journal of Anaesthesiology.2 First, we would like to thank our colleague for his interest in our article. Major bleeding after cardiac surgery remains a serious concern challenging physicians attending cardiac surgical patients. The main underlying mechanisms include decreased thrombin generation, fibrinolysis and platelet dysfunction.3 The origins of these changes are multifactorial; however, cardiopulmonary bypass appears to play a major role.4 Some previous trials have investigated predictive factors for excessive bleeding4–9 and attempted to develop a preoperative risk scoring system.6–9 Surprisingly, the inclusion of intraoperative variables (e.g. the use of cardiopulmonary bypass and/or temperature) does not seem to improve their predictive properties.8,9 Although their predictive performances are acceptable in cardiac surgical patients, these scoring systems are little used by clinicians and their utility remains questionable. Because the HAS-BLED [(Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly)], ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) and HEMORR2HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke) scores have been validated exclusively in noncardiac surgical patients with atrial fibrillation,10 their use for predicting bleeding after cardiac surgery appears to be profoundly hazardous.
Acknowledgements relating to this article
Assistance with reply: none.
Financial support and sponsorship: AO is a member of the independent drug safety monitoring committee (DSMC) for the Nordic Aprotinin Patient Registry (NAPaR) established by Nordic Pharma BV as a requirement of the European regulatory agency. He has received honoraria as consultant to Nordic Pharma.
Conflicts of interest: none.
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