Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface

Johnell, Matilda; Elgue, Graciela; Larsson, Rolf; Larsson, Anders; Thelin, Stefan; Siegbahn, Agneta

doi:10.1067/mtc.2002.122551

Cited by 63 publications

(49 citation statements)

References 43 publications

(64 reference statements)

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“…Studies have shown lower fi brinopeptide A [87], tPA, tPA antigen, prothrombin activator peptide [88,89] and TAT levels [52], indicating both decreased coagulation and fi brinolysis. Heparin bonded circuits, along with improving pulmonary function, also decreased complement activation in pediatric patients resulting in improved coagulation after surgery as evidenced by lower prothrombin time [90].…”

Section: Antifibrinolytic Agentsmentioning

confidence: 97%

Cardiopulmonary Bypass

McLean¹,

Lombardi²,

Pearl³

2008

Cardiovascular Pediatric Critical Illness and Injury

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Section: Antifibrinolytic Agentsmentioning

confidence: 97%

Cardiopulmonary Bypass

McLean¹,

Lombardi²,

Pearl³

2008

Cardiovascular Pediatric Critical Illness and Injury

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“…Because the outer side of the PMEA molecule is chemically inert, its surface has little tendency to react with blood components [ 48 ] . ROCSafe (Terumo) circuit is completely covered with a PMEA coating [ 33 ] Reduced activation of platelets [ 34 ] Reduced activation of the complement system [ 35 ] Limitation of cytokine release [ 36 ] Reduced kallikrein/kinin complex activation [ 37 ] Reduced stimulation of the coagulation system [ 38 ] Suppression of tissue plasminogen activator (tPA) release [ 39 ] Reduced plasmin-antiplasmin complex (PAP) levels [ 40 ] to minimize the adsorption and denaturation of proteins and blood cells during extracorporeal circulation [ 49 ] . Circular dichroism spectroscopy revealed that low-platelet adhesion and spreading are closely related to the low degree of the denaturation of the protein adsorbed onto PMEA.…”

Section: Tubingmentioning

confidence: 99%

MECC Equipment

Anastasiadis¹,

Antonitsis²,

Argiriadou³

2012

Principles of Miniaturized ExtraCorporeal Circulation

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“…16 Modifications of the blood salvage procedure (avoiding the re-infusion of shed mediastinal blood, or return after washing and centrifugation via a cell-saving device) or the use of heparin-bound circuits could limit blood activation and reduce the amount of heparin required. [17][18][19][20][21] The ACT values obtained by different monitors or with different activators cannot be interchanged, particularly during anticoagulation with heparin. 22 A comparative study in patients undergoing percutaneous coronary angioplasty showed that the results of the ACT II® were 130 sec shorter than those of the Hemochron® ACT.…”

Section: S90mentioning

confidence: 99%

Antithrombotic therapy in cardiac surgery

Vincentelli

Jude

Bélisle

2006

Can J Anesth/J Can Anesth

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Purpose: To review the perioperative management of antithrombotic therapy in cardiac surgery, including the management of cardiopulmonary bypass (CPB) and off-pump surgery.Methods: A review of the relevant English literature over the period was undertaken, in addition to a review of international practices in antithrombotic therapy in cardiac surgery. Principal findings:Cardiopulmonary bypass is required in most procedures and makes anticoagulation mandatory. Anticoagulation is, usually, achieved with unfractionnated heparin (UFH). Unfractionated heparin is monitored by point-ofcare (POC) testing, such as the activated clotting time or the determination of heparin concentration. The target values of both tests remain empirical, with no clearly validated thresholds. The target value needs to be adjusted according to the POC test, given significant variations between devices and activators. After CABG, the need for antiplatelet therapy is well demonstrated, in order to limit the risk of postoperative death or ischemic events, and improve venous graft patency. Immediately after valvular surgery, antithrombotic therapy should take into account the specific risk carried by each patient and by each prosthetic device. The risk of venous thromboembolism, though poorly defined, is also present in the postoperative period and may require additional attention. Given the frequent exposure to UFH, occurrence of heparininduced thrombocytopenia is not infrequent in these patients and requires careful individual management. Conclusions:Antithrombotic therapy is an essential component of cardiac surgery. Yet, with the exception of antiplatelet agents in CABG patients, antithrombotic therapy is often based on the clinical experience of medical teams more than on an evidence-based assessment of the literature. Objectif Constatations principales : La circulation extracorporelle est nécessaire pour la majorité des opérations et rend l'anticoagulation obligatoire. L'anticoagulation est, habituellement, réalisée avec de l'héparine non fractionnée (HNF). L'HNF est contrôlée par des tests faits au chevet du malade comme le temps de coagulation activée ou la détermination de la concentration d'héparine. Les valeurs cible des deux tests demeurent empiriques, sans valeurs seuil clairement validées. La valeur cible doit être ajustée en fonction de chaque test de chevet à cause des variations significatives entre les instruments et les activateurs. Après le pontage aortocoronarien (PAC), la nécessité d'un traitement antiplaquettaire a été bien démontrée, qui vise à limiter les décès postopératoires ou les incidents ischémiques et à améliorer la

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Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface

Cited by 63 publications

References 43 publications

Cardiopulmonary Bypass

Cardiopulmonary Bypass

MECC Equipment

Antithrombotic therapy in cardiac surgery

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