Fibrinolysis in coronary artery surgery: detection by thromboelastography

Abstract

Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of assessment (P=0.003) and at 150 min of assessment (P<0.001), the mean values of these parameters were significantly lower in group A as compared with both groups B and C, which were statistically indistinguishable. Lysis on set time on the completion of peripheral bypass anastomoses <50% was detected in 12 patients (52.2%) originating from group A. At the other sampling times (preoperatively, 15 min after sternotomy, at the end of the procedures, and 24 h later) thromboelastographic parameters were similar in all groups. In group A no significant correlations between lysis on set time, postoperative blood loss and D-dimer levels were found. Based on our results, thromboelastographic signs of fibrinolysis were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C.

Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study

“…The concentrations of thrombinantithrombin III complexes and D-dimer have been shown to be increased 24 h after thoracic surgery without CPB. In contrast, substantially greater increases were seen after CPB [18]. Consistent with our findings, patients undergoing surgery with CPB have been shown to exhibit greater activity of PAI-1 in blood [19].…”

Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study

“…The apparent thromboelastographic detection of fibrinolysis/hyperfibrinolysis in conventional CABG (group A), but not in OPCAB (group B) and modified cardiopulmonary bypass (group C) has already been published. 12) This finding is supported by the results of our prospective, randomized pilot study, which had been realized previously with different patients. 13) In that preliminary study we had compared results in 20 patients scheduled for coronary surgery (10 patients OPCAB, 10 patients conventional CABG).…”

Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study

“…There Data are presented in ml, unless otherwise specified was no individual case of fibrinolysis being detected by thromboelastometry in our study, and D-dimers levels remained postoperatively stable and at relatively low levels. Bearing in mind the results of our previous work clearly demonstrating fibrinolytic activity during markedly shorter non-coated cardiopulmonary bypass when no fibrinolytic inhibitors were used [24,25], we suggest that systemic application of tranexamic acid in used dosage is sufficient for satisfactory inhibition of fibrinolytic activity. We are quite aware of the fact that our proportion of patients who required early postoperative surgical revision (12%) is apparently high compared with standard published data (2-6%) [26], but on the other hand most of the operations were complex procedures on a relatively old patient population with an expected higher rate of reexploration [27].…”