Increased fibrinolytic activity in patients undergoing cardiopulmonary bypass operation

Küçük, Ömer; Kwaan, Hau C.; Frederickson, James W.; Wade, Leonard D.

doi:10.1002/ajh.2830230306

Cited by 75 publications

(24 citation statements)

References 18 publications

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“…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]. The amounts of plasmin generated as a consequence of the plasminogen activation may result in a lim ited degradation of fibrinogen, but a signifi cant degradation of cross-linked fibrin.…”

Section: Discussionmentioning

confidence: 84%

“…The abnormalities most frequently found in clude heparin and protamine excess, heparin rebound, low platelet count, abnormal plate let function, increased fibrinolysis, and dis seminated intravascular coagulation (DIC) [6,7]. Increased fibrinolysis could contribute to postoperative bleeding, whereas a postopera tive fibrinolytic shutdown could be a risk factor taken into consideration in the ap pearance of thrombosis [4,5,8],…”

Section: Introductionmentioning

confidence: 99%

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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: 84%

Section: Introductionmentioning

confidence: 99%

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Páramo

Rifón

Llorens

et al. 1991

Pathophysiol Haemos Thromb

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“…Increased fibrinolysis during this period has been demonstrated by several other investigators. 16,23,[31][32][33][34][35] The usefulness of EACA to treat excessive bleeding after aortocoronary bypass was reported by Lambert in 1979. 36 Using the prothrombin time, partial thromboplastin time, fibrinogen level, and tri-F titer tests, hyperfibrinolytic bleeding was the most frequently identifiable coagulation disorder and was diagnosed in 20% of the patients.…”

Section: Eaca and Ta In Cardiac Surgerymentioning

confidence: 99%

Natural and synthetic antifibrinolytics in cardiac surgery

1992

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In an effort to reduce morbidity associated with transfusion of blood products, the use of antifibrinolytics to decrease bleeding and transfusions after cardiopulmonary bypass ( CPB) is receiving widespread attention. The predominant haemostatic defect induced by CPB and, therefore Afin de rdduire morbiditd associde aux transfusion sanguines, les anesthdsistes et les chirurgiens cardiaques utilisent de plus en plus les antifibrinolytiques darts le but de diminuer le saignement et les besoins transfusionnels secondaires it la circulation extracorporelle ( CEC). Les modifications de l 'hdmostase induites

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“…Ainda durante a circulação extracorpórea, devido à hemodiluição, à hipotermia, ao trauma dos elementos figurados do sangue e à liberação de substâncias vasoativas, observa-se alterações nas plaquetas, nas proteínas relacionadas à coagulação e no sistema fibrinolítico, conforme descreveram HORROW (1) , ELLISON & JOBES (2) e KUCUK et al (3) .…”

Section: Introductionunclassified

Estudo comparativo do emprego da aprotinina em baixas doses X placebo, durante a circulação extracorpórea

Pontes¹,

Matos²,

Medeiros³

et al. 2002

Rev Bras Cir Cardiovasc

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do emprego da aprotinina em baixas doses X placebo, durante a circulação extracorpórea. Rev Bras Cir Cardiovasc 2002; 17(1): 47-53. RESUMO: Fundamentos: A aprotinina, um antifibrinolítico de natureza protéica, tem sido proposta pela literatura, no intuito de minimizar os efeitos adversos da circulação extracorpórea ao sistema fibrinolítico, permitindo assim uma hemostasia mais adequada.Objetivo: Estudar comparativamente o efeito da utilização profilática de baixas doses de aprotinina em pacientes submetidos à circulação extracorpórea.Método: Dezessete pacientes portadores de valvopatia mitral submetidos a correção cirúrgica utilizandose circulação extracorpórea foram aleatoriamente divididos em dois grupos: I (controle) -9 pacientes nos quais foi administrado placebo no perfusato e a cada hora de CEC; II (aprotinina) -8 pacientes nos quais foram administrados 30000 KIU/kg e 7500 KIU/kg de aprotinina adicionados ao volume do perfusato a cada hora de CEC. O volume total de sangramento pós-operatório nas primeiras 24 horas foi monitorado, assim como amostras sangüíneas foram colhidas após indução anestésica e após a neutralização da heparina com sulfato de protamina para que os seguintes parâmetros fossem avaliados: atividade de protrombina (AP), tempo de tromboplastina parcial ativado (TTPA), tempo de trombina (TT), dosagem de fibrinogênio, concentração de antitrombina III (ATIII), tempo de lise da euglobulina (TLE) e dosagem do dímero -D (DDi).Resultados: O volume médio total de sangramento nas primeiras 24 horas no grupo controle foi 690,67 ± 377,12, enquanto que no grupo da aprotinina em baixas doses foi de 248,75 ± 103,13 (p=0,0017). No quadro abaixo estão apresentados os resultados obtidos a partir das análises das amostras sangüíneas pré e pós-operatórias comparativas dos grupos controle (I) e aprotinina (II). Conclusão:A utilização da aprotinina, em baixa dose, foi eficaz na redução do sangramento, assim na diminuição da fibrinólise.

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Increased fibrinolytic activity in patients undergoing cardiopulmonary bypass operation

Cited by 75 publications

References 18 publications

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Natural and synthetic antifibrinolytics in cardiac surgery

Estudo comparativo do emprego da aprotinina em baixas doses X placebo, durante a circulação extracorpórea

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