The Molecular Effect of Tubing Length in Cardiopulmonary Bypass on Coagulation Factors

Aim: Coagulation factors may be affected depending on the tubing line lengths of CPB. The aim of this retrospective study was to evaluate the effect of CPB tubing line lengths on coagulation factors and to assess the relationship of these effects with bleeding and transfusion rates and early clinical outcomes. Methods: In this planned retrospective study, after applying the exclusion criteria, the included patients were divided into two groups based on tubing line lengths. Those with shorter tubing line lengths were defined as Group 1 and those with longer tubing line lengths than the first group were defined as Group 2. Coagulation factors, bleeding and transfusion rates of the groups were compared and statistical analyses were performed. Results: Demographic, descriptive and preoperative data of the groups included in the study were similar (p>0.005). There was a statistically significant difference between the postoperative day 1 and early postoperative clinical outcomes including PT, PTT, INR, APTT.2, factor 4, platelets, haemoglobin, haematocrit, erythrocytes, postoperative bleeding rate, postoperative transfusion rate, postoperative intubation time and ICU length of stay (p0.005). Conclusion: In this study, we found that tubing line lengths in CPB-guided cardiac surgery have effects on coagulation factors and also increase the postoperative bleeding rate and consequently increase the transfusion rate. The findings of this clinical study suggest that longer CPB tubing sets not only affect laboratory coagulation parameters but also trigger coagulation and inflammation pathways at the molecular level through blood-biomaterials interactions. This can be linked to molecular events such as thrombin production, platelet activation, and the release of endothelium-derived pro-inflammatory markers, providing an explanatory mechanism for the clinical outcomes of the study.