Association of the 98T ELAM-1 Polymorphism With Increased Bleeding After Cardiac Surgery

Ian J. Welsby, Mihai V. Podgoreanu, Barbara Phillips-Bute, Richard Morris, Joseph P. Mathew, Peter K. Smith, Mark F. Newman, Debra A. Schwinn, Mark Stafford-Smith

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: Hemorrhage continues to be a major problem after cardiac surgery despite the routine use of antifibrinolytic drugs, with striking inter-patient variability poorly explained by already known risk factors. The authors tested the hypothesis that genetic polymorphisms of inflammatory mediators and cellular adhesion molecules are associated with bleeding after cardiac surgery. Design: Prospective, observational study. Setting: Single, tertiary referral university heart center. Participants: Adult patients undergoing aortocoronary surgery with cardiopulmonary bypass. Interventions: Patients (n = 759) had 10 mL of blood drawn preoperatively and genomic DNA isolated then genotyped for 17 polymorphisms in 7 candidate genes: tumor necrosis factor, interleukins 1β and 6, interleukin 1 receptor antagonist, intercellular adhesion molecule-1 (ICAM-1), P-selectin and endothelial leucocyte adhesion molecule-1 (E-selectin). Multivariate analyses were used to relate clinical and genetic factors to bleeding and transfusion. Measurements and Main Results: The 98G/T polymorphism of the E-selectin gene was independently associated with bleeding after cardiac surgery (p = 0.002), after adjusting for significant clinical predictors (patient size and baseline hemoglobin concentration). There was a gene dose effect according to the number of minor alleles in the genotype; carriers of the minor allele bled 17% (GT) and 54% (TT) more than wild type (GG) genotypes, respectively (p = 0.01). Carriers of the minor allele also had longer activated partial thromboplastin times (p = 0.0023) and increased fresh frozen plasma transfusion (p = 0.03) compared with wild type. Conclusions: The authors found a dose-related association between the 98T E-selectin polymorphism and bleeding after cardiac surgery, independent of and additive to standard clinical risk factors.

Original languageEnglish
Pages (from-to)427-433
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number3
StatePublished - 2010


  • E-selectin
  • ELAM-1
  • aortocoronary surgery
  • cardiopulmonary bypass
  • genes
  • hemorrhage/postoperative complications
  • polymorphism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Association of the 98T ELAM-1 Polymorphism With Increased Bleeding After Cardiac Surgery'. Together they form a unique fingerprint.

Cite this