Hemostatic Defects Induced by Cardiopulmonary Bypass

Bick, Rodger L.; Arbegast, Neil R.; Crawford, L M; Holterman, Margaret; Adams, Thompson; Schmalhorst, William R.

doi:10.1177/153857447500900407

Cited by 26 publications

(34 citation statements)

References 32 publications

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“…Previous results on fibrinolysis parameters during CPB sur gery seem to agree with intraoperative plas minogen activation, as assessed by euglobulin lysis time, EFA, plasminogen and FDP levels [4, 5, 14-18] wich, to some extent, could contribute to postoperative bleeding. Some authors, however, found no changes in plasminogen [14], and even decreased EFA has been reported [19]. As far as plasmin inhibitors are concerned, there is evidence for a significant drop of a2-AP and other plasmin inhibitors during surgery [5,20], although some authors found no significant changes [17], Finally, the higher D-dimer levels found in our patients may have clini cal implications, as they could indicate that fibrin is newly formed in the circulation dur ing bypass as a result of decreased vascular perfusion, or in pooled blood in the heart during cardioplegia [4].…”

Section: Discussionmentioning

confidence: 95%

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Páramo

Rifón

Llorens

et al. 1991

Pathophysiol Haemos Thromb

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The influence of cardiopulmonary bypass (CPB) on fibrinolytic activity was assessed in 100 patients with valvular heart disease or atrial septal defects. Euglobulin fibrinolytic activity (EFA), tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor 1 (PAI-1) activity, plasminogen, α₂-antiplasmin (α₂-AP), fibrinogen degradation products (FDP), and D-dimer were measured pre-, intra-, and postoperatively. There were significant increases in EFA and t-PA activity (p < 0.002), and decreases in plasminogen and α₂-AP (p < 0.0001) intraoperatively with respect to baseline values. t-PA activity decreased significantly after surgery (p < 0.002), whereas PAI-1 activity showed a marked increase shortly after operation and on postoperative day 1 (p < 0.0001). FDP and D-dimer levels were significantly increased both intra- and postoperatively, the latter showing higher values (p < 0.01 and p < 0.0001, respectively). This study shows that there is an activation of the fibrinolytic system, as a result of the increased activation of plasminogen and decreased levels of plasmin inhibitors, during CPB surgery followed by a postoperative fibrinolytic shutdown.

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Section: Discussionmentioning

confidence: 95%

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Páramo

Rifón

Llorens

et al. 1991

Pathophysiol Haemos Thromb

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“…Previous investigators have reported circulating plasmin to be elevated during CPB, to increase further after protamine infusion, and to remain elevated at i h post-surgery [13,14]. However, the mechanisms by which CPB and protamine affect fibrinolytic activity are still unclear.…”

Section: Discussionmentioning

confidence: 98%

Centrifugal and roller pumps — are there differences in coagulation and fibrinolysis during and after cardiopulmonary bypass?

et al. 1995

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A number of hemostatic parameters reflecting the activation of coagulation and fibrinolysis were investigated in a prospective study of 24 patients undergoing cardiopulmonary bypass (CPB) during heart surgery. The patients were randomized to a group in which either a roller (group 1) or a centrifugal pump (group 2) was used. Blood samples were taken preoperatively, at the onset of and every 20 min during CPB, after the administration of protamine, and 4, 20, 44, and 68 h postoperatively. The groups did not differ significantly in hematocrit, fibrinogen, factor XIII, and antithrombin III. Significant differences in favor of group 2 during and after CPB were found in prothrombin fragment F1 + 2, plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TAT), and D-dimer (F1 + 2 P < 0.01 after 80-min CPB, PAP P < 0.005 after 40-min CPB, TAT and D-dimer P < 0.05 after 100-min CPB, D-dimer and PAP P < 0.05 after protamine administration, TAT and F1 + 2 4 h after CPB). These findings indicate the activation of fibrinolysis preceding thrombin generation during cardiopulmonary bypass. In addition, we conclude that centrifugal blood pumping is beneficial in avoiding excessive activation of both coagulation and fibrinolysis.

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“…Some studies finding thrombocytopenia during CPB concluded that this represented thrombocytopenia of DIC. 54,72,158,159 We, [32][33][34][35]42,43 as well as others, 63,74,146 have failed to find significant thrombocytopenia during CPB. This wide variability in experience most likely represents different surgical and pumping techniques, such as flow rates, normothermic perfusion, or hypothermic perfusion, the oxygenation system used, time on bypass, and the priming solution.…”

Section: Thrombocytopeniamentioning

confidence: 99%

Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits

Bick¹

1985

Semin Thromb Hemost

204

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This discussion has provided a review of the available literature regarding alterations of hemostasis associated with CPB surgery, the use of prosthetic devices, and apheresis. The key to prevention of CPB hemorrhage is to obtain an adequate preoperative workup. Of extreme importance is an adequate history with respect to bleeding tendencies and thrombotic tendencies in both the patient and the family; of equal importance is a careful history regarding the use of drugs affecting hemostasis, especially drugs known to interfere with platelet function. A careful physical examination, searching for clues of a real or potential bleeding diathesis, may also prevent catastrophic cases of hemorrhage. An adequate presurgical screen must be performed in surgical patients. In addition to the usual prothrombin time, partial thromboplastin time, and platelet count, a standardized template bleeding time (and thrombin time in patients subjected to CPB) should be performed. The use of these simple testing modalities will guard against significant defects in vascular and platelet function. Most instances of nontechnical surgical and cardiovascular surgical hemorrhage are due to several well-defined defects in hemostasis that should be readily controlled if approached in a logical manner as a team effort among surgeons, pathologists, and hematologists.

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Hemostatic Defects Induced by Cardiopulmonary Bypass

Cited by 26 publications

References 32 publications

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Centrifugal and roller pumps — are there differences in coagulation and fibrinolysis during and after cardiopulmonary bypass?

Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits

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