Cardiothoracic & vascular anaesthesia
Factor XII (FXII) decline during cardiopulmonary bypass and the limits of routine coagulation assays: a prospective observational analysis
Authors' conclusion
CPB induced a significant reduction in FXII activity. Global coagulation assays such as aPTT or ROTEM have limited sensitivity for contact factor deficiencies.
Study context
- Population
- Adults undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) (10 coronary artery bypass grafting (CABG), 10 aortic aneurysm repair)10 CABG, 10 aortic
- Participants
- 20 adults
- Exposure
- FXII activity before anaesthesia induction vs 3 min after protamine
- Outcome
- FXII activity
Main finding
As reported in the abstract
FXII activity, whole cohort (before vs after CPB)
- FXII activity decreased significantly after CPB, whole cohort (before vs after)
- 98% (79/122) vs. 62% (51/83)
- P value
- p < 0.001
Observational data: associations, not effects.
Further findings
FXII activity, CABG (subgroup; before vs after CPB)
- FXII activity decreased significantly after CPB in CABG
- 108% (83/124) vs. 64% (47/85)
- P value
- P < 0.001
FXII activity, aortic surgery (subgroup; before vs after CPB)
- FXII activity decreased significantly after CPB in aortic surgery
- 92% (75/119) vs. 61% (52/82)
- P value
- P < 0.001
Factor V (FV) and factor VIII (FVIII) activity
- FV declined, whereas FVIII tended to increase
Activated partial thromboplastin time (aPTT)
- aPTT prolongation minimal, remained within normal range
Correlation of FXII decline with aPTT change, CABG (subgroup)
- Strong correlation only in CABG patients (ρ)
- - 0.835
- P value
- P = 0.003
ROTEM clotting times
- Moderately prolonged after CPB; no correlation with FXII activity
Original publication
FXII decline during cardiopulmonary bypass and the limits of routine coagulation assays: a prospective observational analysis. Perioper Med (Lond). Published 30 April 2026. doi:10.
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