Article type
Abstract
Background: The occurrence of perioperative hypothermia is a serious event, with consequences that include increased intraoperative bleeding caused by altered coagulation and hemostatic mechanisms. Hence, maintaining normothermia during the intraoperative period is necessary to prevent complications. Despite the significance of these events, evidence regarding causal factors remains inconclusive.
Objectives: To synthesize knowledge concerning perioperative hypothermia and alterations in coagulation biomarkers among patients undergoing elective surgery.
Methods: A systematic review was conducted following JBI Collaboration guidelines, with registration available under number 10.17605/OSF.IO/2P36Y. The search encompassed databases Academic Search Premier, CINAHL Ultimate, Cochrane Central, Embase, Lilacs, PubMed, and Web of Science Core Collection, alongside searches in grey literature using Open Grey. The search strategy employed the descriptors "Hypothermia", "Hemostasis", "Perioperative", and their synonyms, combined with Boolean operators AND and OR. Primary studies involving adult and elderly surgical patients, measuring temperature parameters and collecting coagulation biomarkers were included, without language restrictions. Two reviewers independently conducted study selection, data extraction and methodological assessment. To assess methodological quality, a specific instrument from the JBI Collaboration was used.
Results: Five studies were included. No significant differences were observed in prothrombin time and fibrinogen plasma concentrations. Hypothermic patients exhibited reduced platelet count and fibrinogen levels, along with prolonged prothrombin time, activated partial thromboplastin time, and a significant decrease in hemoglobin. Patients subjected to passive warming methods experienced decreased body temperature and significantly prolonged activated partial thromboplastin and bleeding times compared to normothermic patients. The authors recommended using prothrombin time and partial thromboplastin time as standard tests for assessing coagulation factors. One study suggested adding pH assessment as a complementary measure for evaluating coagulation disorders.
Conclusions: Hypothermia has been demonstrated to affect the coagulation cascade and laboratory tests and biomarkers. However, there is no clear consensus on which tests should be conducted and when, as intraoperative coagulation induced by hypothermia does not directly correlate with hemorrhage assessment in clinical practice.
Objectives: To synthesize knowledge concerning perioperative hypothermia and alterations in coagulation biomarkers among patients undergoing elective surgery.
Methods: A systematic review was conducted following JBI Collaboration guidelines, with registration available under number 10.17605/OSF.IO/2P36Y. The search encompassed databases Academic Search Premier, CINAHL Ultimate, Cochrane Central, Embase, Lilacs, PubMed, and Web of Science Core Collection, alongside searches in grey literature using Open Grey. The search strategy employed the descriptors "Hypothermia", "Hemostasis", "Perioperative", and their synonyms, combined with Boolean operators AND and OR. Primary studies involving adult and elderly surgical patients, measuring temperature parameters and collecting coagulation biomarkers were included, without language restrictions. Two reviewers independently conducted study selection, data extraction and methodological assessment. To assess methodological quality, a specific instrument from the JBI Collaboration was used.
Results: Five studies were included. No significant differences were observed in prothrombin time and fibrinogen plasma concentrations. Hypothermic patients exhibited reduced platelet count and fibrinogen levels, along with prolonged prothrombin time, activated partial thromboplastin time, and a significant decrease in hemoglobin. Patients subjected to passive warming methods experienced decreased body temperature and significantly prolonged activated partial thromboplastin and bleeding times compared to normothermic patients. The authors recommended using prothrombin time and partial thromboplastin time as standard tests for assessing coagulation factors. One study suggested adding pH assessment as a complementary measure for evaluating coagulation disorders.
Conclusions: Hypothermia has been demonstrated to affect the coagulation cascade and laboratory tests and biomarkers. However, there is no clear consensus on which tests should be conducted and when, as intraoperative coagulation induced by hypothermia does not directly correlate with hemorrhage assessment in clinical practice.