PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

Abstract

BackgroundEnhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor – 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding.MethodsTotally 88 adult patients (mean age 66 ± 10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ≤ 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS.ResultsNine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = − 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P < 0.001 and P = 0.012, respectively). Group I displayed significantly lower plasma concentrations of fibrinogen and higher levels of D-dimer from immediately after the operation and throughout the first 24 hours postoperatively.ConclusionsLower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery.

Risk factors of acute coagulation dysfunction after aneurysmal subarachnoid hemorrhage

“…Previous studies indicated that higher tissue plasminogen activator (tPA) and lower activity of plasminogen activator inhibitor (PAI) were detected in older patients. And after surgery, lower plasma concentrations of PAI-1 preoperatively leads to higher plasma levels of D-dimer in association with coagulopathy [22]. However, increasing age was not related to higher postoperative hemorrhage and infarction, which was consistent with our findings.…”

Effect of two doses of tranexamic acid on fibrinolysis evaluated by thromboelastography during cardiac surgery

“…Additional highly sensitive tests (such as plasmin antiplasmin assays, euglobulin time) have been described in the literature to evaluate fibrinolysis. 19 Greilich et al 20 used D-dimers to evaluate the effect of epsilon aminocaproic acid (EACA) and aprotinin on fibrinolysis. They reported that, even if D-dimers were not different between EACA and aprotinin groups, the use of the two drugs was associated with a decrease in D-dimers compared with placebo.…”

Hemorrhagic disorders of fibrinolysis: a clinical review

“…In a study of 270 patients with bleeding of unknown cause, patients had higher tPA activity levels and lower levels of tPA-PAI-1 complexes and lower PAI-1 levels, indicating a possible underlying hyperfibrinolytic disorder [5]. In a cohort of patients undergoing cardiac surgery, postoperative blood loss was associated with lower preoperative levels of PAI-1 and lower postoperative tPA-PAI-1 levels [108]. On the other hand, a study evaluating fibrinolysis in patients with a mild-to-moderate bleeding tendency of unknown cause showed no differences in PAI-1 levels between patients and healthy controls.…”