Hyperfibrinolysis in out of hospital cardiac arrest is associated with markers of hypoperfusion

Viersen, V.A.; Greuters, Sjoerd; Korfage, A.R.; Rijst, C. van der; Bochove, V. van; Nanayakkara, Prabath W.B.; Vandewalle, E.; Boer, Christa

doi:10.1016/j.resuscitation.2012.05.008

Cited by 46 publications

(42 citation statements)

References 20 publications

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“…More recently, our group used ROTEM to show that potential uDCD donors universally suffer hyperfibrinolysis at the moment death is declared . Other groups have used thromboelastometry to study patients suffering CA, and it appears that the incidence of hyperfibrinolysis increases in relation to the length of arrest and warm ischemia . When organs and tissues suffer progressive ischemia, thrombomodulin, an integral membrane protein expressed on the surface of endothelial cells, is induced.…”

Section: Discussionmentioning

confidence: 99%

Heparin but not tissue plasminogen activator improves outcomes in donation after circulatory death liver transplantation in a porcine model

et al. 2018

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Ischemic-type biliary lesions (ITBLs) arise most frequently after donation after circulatory death (DCD) liver transplantation and result in high morbidity and graft loss. Many DCD grafts are discarded out of fear for this complication. In theory, microvascular thrombi deposited during donor warm ischemia might be implicated in ITBL pathogenesis. Herein, we aim to evaluate the effects of the administration of either heparin or the fibrinolytic drug tissue plasminogen activator (TPA) as means to improve DCD liver graft quality and potentially avoid ITBL. Donor pigs were subjected to 1 hour of cardiac arrest (CA) and divided among 3 groups: no pre-arrest heparinization nor TPA during postmortem regional perfusion; no pre-arrest heparinization but TPA given during regional perfusion; and pre-arrest heparinization but no TPA during regional perfusion. In liver tissue sampled 1 hour after CA, fibrin deposition was not detected, even when heparin was not given prior to arrest. Although it was not useful to prevent microvascular clot formation, pre-arrest heparin did offer cytoprotective effects during CA and beyond, reflected in improved flows during regional perfusion and better biochemical, functional, and histological parameters during posttransplantation follow-up. In conclusion, this study demonstrates the lack of impact of TPA use in porcine DCD liver transplantation and adds to the controversy over whether the use of TPA in human DCD liver transplantation really offers any protective effect. On the other hand, when it is administered prior to CA, heparin does offer anti-inflammatory and other cytoprotective effects that help improve DCD liver graft quality. Liver Transplantation 24 665-676 2018 AASLD.

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Section: Discussionmentioning

confidence: 99%

Heparin but not tissue plasminogen activator improves outcomes in donation after circulatory death liver transplantation in a porcine model

et al. 2018

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“…1). Studies in cardiac arrest [62,63] and TIC [12,51,52 & ] demonstrate that severe shock is a key driver of fibrinolytic activation. In trauma patients, both ISS and shock are associated with high tPA and low PA1-1 [51,52 & ], revealing a spectrum of lysis dependent on the extent of injury, shock and balance between tPA and PAI-1 (Fig.…”

Section: Importance Of the Fibrinolytic Systemmentioning

confidence: 99%

Cause of trauma-induced coagulopathy

Davenport

Brohi

2016

Current Opinion in Anaesthesiology

129

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“…23 Hyperfibrinolysis is reportedly common in OHCA patients and has been associated with markers of hypoperfusion in these patients. 24,25 If not improved, DIC with the fibrinolytic phenotype during the early stage of OHCA proceeds to the thrombotic phenotype at the later stage of OHCA. 20 Both types of DIC affect the patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

et al. 2017

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Objective: This study aimed to test the hypothesis that coagulation, fibrinolytic markers and disseminated intravascular coagulation (DIC) score (International Society on Thrombosis and Haemostasis) at hospital admission of out-of-hospital cardiac arrest (OHCA) patients can predict neurological outcomes 1 month after cardiac arrest. Results: We analyzed data for 315 patients. Except for fibrinogen level, all coagulation variables, fibrinolytic variables, and DIC score were associated with favorable neurological outcomes. In the receiver operating characteristic curve analysis, FDP level had the largest area under the curve (AUC; 0.795). In addition, the AUC of FDP level was larger than that of 4 lactate level. The AUC value of FDP level might indicate that FDP is an independent predictor of favorable neurological outcomes. Conclusions:All of the coagulation and fibrinolytic markers, except for fibrinogen level, and DIC score at hospital admission, were associated with favorable neurological outcomes. Of all of the variables, FDP level was most closely associated with favorable neurological outcomes in OHCA patients who successfully achieved ROSC. 5

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Hyperfibrinolysis in out of hospital cardiac arrest is associated with markers of hypoperfusion

Abstract: A substantial part of OHCA patients develop hyperfibrinolysis in association with markers for hypoperfusion. Our data further suggest that the time to the onset of clot lysis may be an important marker for the severity of hyperfibrinolysis and patient outcome.

Cited by 46 publications

References 20 publications

Heparin but not tissue plasminogen activator improves outcomes in donation after circulatory death liver transplantation in a porcine model

Heparin but not tissue plasminogen activator improves outcomes in donation after circulatory death liver transplantation in a porcine model

Cause of trauma-induced coagulopathy

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

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