Antifibrinolytic Therapy and Perioperative Considerations

Levy, Jerrold H.; Koster, Andreas; Quiñones, Quintin J.; Milling, Truman J.; Key, Nigel S.

doi:10.1097/aln.0000000000001997

Cited by 116 publications

(106 citation statements)

References 99 publications

(133 reference statements)

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“…7 Fibrinolytic shutdown that also occurs in sepsis is characterized by increased PAI-1 activity, resulting in low D-dimers. 31,32 Vascular endothelial injury not only causes further thrombocytopenia and reduction of natural anticoagulants, but also hemostatic activation as the phenotypic expression of thrombotic DIC. Analysis of septic patients who are coagulopathic and receive serine protease inhibitors such as antithrombin or thrombomodulin suggest that there may be a survival benefit in post hoc analyses.…”

Section: Inflammation and Coagulationmentioning

confidence: 99%

COVID-19 and its implications for thrombosis and anticoagulation

Connors

Levy

2020

Blood

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2,158

2,391

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Severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019 (COVID-19)-induced infection can be associated with a coagulopathy, findings consistent with infection-induced inflammatory changes as observed in patients with disseminated intravascular coagulopathy (DIC). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding management of the complications that arise in the course of this viral illness. The lungs are the target organ for COVID-19; patients develop acute lung injury that can progress to respiratory failure, although multiorgan failure can also occur. The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen-degradation products, whereas abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon in initial presentations. Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested. COVID-19–associated coagulopathy should be managed as it would be for any critically ill patient, following the established practice of using thromboembolic prophylaxis for critically ill hospitalized patients, and standard supportive care measures for those with sepsis-induced coagulopathy or DIC. Although D-dimer, sepsis physiology, and consumptive coagulopathy are indicators of mortality, current data do not suggest the use of full-intensity anticoagulation doses unless otherwise clinically indicated. Even though there is an associated coagulopathy with COVID-19, bleeding manifestations, even in those with DIC, have not been reported. If bleeding does occur, standard guidelines for the management of DIC and bleeding should be followed.

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Section: Inflammation and Coagulationmentioning

confidence: 99%

COVID-19 and its implications for thrombosis and anticoagulation

Connors

Levy

2020

Blood

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2,158

2,391

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“…In theory, AF should have its most favorable effect in those with hyperfibrinolysis. In contrast, hypercoagulability associated with fibrinolytic shutdown is reported to occur in 46% to over 64% of trauma patients [22][23][24][25][26][27][28][29][30][31][32] . On this basis alone, it is reasonable to propose that all patients likely do not benefit from TXA 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, AF is often used in this population to minimize perioperative blood loss 42 . It is well established that AF therapy reduces bleeding and allogeneic transfusion requirements 29 . Myles et al studied the effectiveness of TXA versus placebo in a randomized control study of 4631 coronary-artery surgical patients and demonstrated that death or thrombotic complication occurred in 18.1% of placebo patients versus 16.7% of TXA patients 43 .…”

Section: Discussionmentioning

confidence: 99%

Fibrinolysis Phenotypes Differ Amongst Cardiac Surgery Patients: Antifibrinolytic Therapy for All?

Sussman¹,

Urréchaga²,

Cioci³

et al. 2020

Preprint

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The recognition of fibrinolysis phenotypes in trauma patients has led to a reevaluation of antifibrinolytic therapy (AF). Many cardiac patients also receive AF, however the distribution of fibrinolytic phenotypes in that population is unknown. The purpose of this study was to fill that gap. Methods: Data were retrospectively reviewed from 78 cardiac surgery patients. Phenotypes were defined as hypofibrinolytic (LY30 <0.8%), physiologic (LY30 0.8-3.0%) and hyperfibrinolytic (LY30 >3%). Continuous variables were expressed as M ± SD or median (interquartile range). Results: The study population was 65±10 yrs old, 74% male, average body mass index of 29±5 kg/m2. Fibrinolytic phenotypes were distributed as physiologic=45%, hypo=32% and hyper = 23%. There was no obvious effect of age, gender, race, or ethnicity on the distribution of fibrinolysis phenotypes; 47% received AF. The time with chest tube during post-operative recovery was longer in those who received AF (4[3,5] days) vs no AF (3[2,4] days), P=0.037). All cause morbidity occurred in 51% of patients who received AF vs 25% with no AF (p=0.017). However, with AF vs no AF, apparent differences in median chest tube output (1379 vs 820ml, p=0.075), hospital LOS (13 vs 10 days, P=0.873), estimated blood loss (1100 vs 775 ml, P=0.127), units of transfused RBCs (4 vs 2], P=0.152) or all-cause mortality (5.4% [2/37] vs 10% [4/41], P=0.518) were not statistically significant. Conclusion: This is the first description of three distinctly different fibrinolytic phenotypes in cardiac surgery patients. In this population, the use of AF was associated with increased morbidity.

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“…Tranexamic acid works as an anti-fibrinolytic agent by inhibiting the breakdown of polymer fibrin by plasmin, so that hemostasis can occur more effectively (Levy et al, 2018 Figure 1. et al, 2017).…”

Section: Bleeding Timementioning

confidence: 99%

Effect of Broccoli (Brassica oleracea L. var. italica) Extract on Bleeding Time in Male White Mice (Mus musculus L.)

Sammulia¹,

Almahdy²,

Rezky³

2020

Borneo J Pharm

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Cessation of bleeding is influenced by many factors including the type of medication used. The use of drugs to stop bleeding can be done in various ways, one of which is the use of traditional medicine. One of the traditional plants that can be used as a stop bleeding is broccoli (Brassica oleracea L. var. italica) which has a fairly high vitamin K content, where is efficacious as hemostatic. This study aims to determine the effect of broccoli on the bleeding time of mice tail cuts. The first group was negative control (Na-CMC), the second group was positive control (tranexamic acid), while groups three, four, and five were broccoli extract dose of 20, 40, and 60 mg/kg BW, respectively. All treatments were given orally for seven days. Bleeding time was calculated from the initial blood loss until the blood stopped (tail bleeding I method) and the data were analyzed with the ANOVA one way test and the post hoc Least Significant Difference (LSD) statistical test. The results showed that there were differences in the time to stop bleeding in the treatment control group at a dose of 20 mg/kg BW (122.60 � 29.535 seconds), 40 mg/kg BW (102.40 � 9.607 seconds) and 60 mg/kg BW (90.40 � 3.845 seconds). From these results, it can be concluded that the extract of broccoli at a dose of 60 mg/kg BW gives the best results as hemostatic, while the effect is almost similar to the positive control group.

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Antifibrinolytic Therapy and Perioperative Considerations

Cited by 116 publications

References 99 publications

COVID-19 and its implications for thrombosis and anticoagulation

COVID-19 and its implications for thrombosis and anticoagulation

Fibrinolysis Phenotypes Differ Amongst Cardiac Surgery Patients: Antifibrinolytic Therapy for All?

Effect of Broccoli (Brassica oleracea L. var. italica) Extract on Bleeding Time in Male White Mice (Mus musculus L.)

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