The Treatment of Postperfusion Bleeding Using ε-Aminocaproic Acid, Cryoprecipitate, Fresh-Frozen Plasma, and Protamine Sulfate

Lambert, Cary J.; Marengo-Rowe, Alain J.; Leveson, James E.; Green, Robert H.; Thiele, Jörn; Geisler, Gerald F.; Adam, Maurice; Mitchel, Ben F.

doi:10.1016/s0003-4975(10)63153-0

Cited by 71 publications

(9 citation statements)

References 12 publications

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“…They reported that medical and surgical causes of bleeding could be differentiated using a combination of the tests that included the aPTT, PT, fibrinogen level and tri-F titer (times of sample collection not defined). 34,35 The authors treated patients, in whom bleeding was attributed to increased fibrinolysis, with c-aminocaproic acid. However, the study group was not compared with a group of bleeding patients who were not so treated.…”

Section: Importantly Without Distinct Differences Between the Rangesmentioning

confidence: 99%

Changes in Blood Coagulation During and Following Cardiopulmonary Bypass:Lack of Correlation With Clinical Bleeding

et al. 1996

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Although previous studies have documented a wide variety of derangements in laboratory measurements of blood coagulation and platelets during cardiopulmonary bypass, limited data are available concerning the magnitude of these changes and any association with excessive bleeding.To determine whether abnormalities in commonly available laboratory tests for the evaluation of coagulation, fibrinolysis and hemostasis correlate with postoperative blood loss and transfusion requirements as measures of clinical outcome, 47 consecutive patients undergoing coronary artery bypass grafting with hypothermic cardiopulmonary bypass (CPB) were studied prospectively at 12 time points before, during, and following CPB. Routine blood coagulation tests, coagulation factor levels (fibrinogen, V, VII, VIII, and IX) and fibrinolysis (FDP) became abnormal within 15 minutes after patients were placed on CPB, remained abnormal for the duration of CPB, and recovered at varying rates after discontinuation of CPB. Mean factor V levels declined by the greatest percentage, to 15% of normal, followed by factor VIII which decreased to 30%. Platelet counts declined to below 100 X 10 9 /L after Diagnosing the cause of intra-or postoperative hemorrhage in patients undergoing cardiopulmonary bypass (CPB) is a difficult clinical problem. A number of alter- Supported in part by the Department of Veterans Affairs and Research Grant HL31035 from the National Heart, Lung, and Blood Institute, National Institutes of Health.Presented in part at the 36th Annual Meeting of the American Society of Hematology, Nashville, Tennessee, December 2-6, 1994 (Blood 199484[suppl l]:469a).Manuscript received October 27, 1995; revision accepted January 8, 1996.Address reprint requests to Dr. Levin: Department of Laboratory Medicine, VAMC (111H2), 4150 Clement Street, San Francisco, CA 94121. the initiation of CPB and remained low in the postoperative period. Twenty-eight percent of patients had mediastinal output a 100 mL per hour during the immediate postoperative period, and were considered to be "bleeders." There were no clinically relevant differences in any of the laboratory measurements between patients with normal postoperative blood loss and those defined as bleeders. Thus, the absence of significant correlations between various laboratory measurements of hemostasis and actual postoperative bleeding indicates that these laboratory derangements are transient, are not predictive of clinically important hemostatic abnormalities, and should not be used in isolation to guide the use of blood components in these patients. Furthermore, although bleeders received more blood components, there was surprisingly little effect on the coagulation factor levels measured.

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Section: Importantly Without Distinct Differences Between the Rangesmentioning

confidence: 99%

Changes in Blood Coagulation During and Following Cardiopulmonary Bypass:Lack of Correlation With Clinical Bleeding

et al. 1996

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“…In addition, heparin rebound and protamine excess have been described as causing prolonged activated clotting time and an anticoagulant effect [30-331. Consumptive coagulopathy and enhanced fibrinolysis have also been associated with cardiopulmonary bypass [34,35]. In different studies increases of FDP, D-dimer, and TAT as well as increased plasminogen activator and shortening of euglobulin lysis time were reported [ 13,14,29,36].…”

Section: __mentioning

confidence: 99%

Hypercoagulable state induced by thrombocytapheresis

Kobayashi

Hamaoka

Ozawa

et al. 1993

J of Clinical Apheresis

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The influence of the continuous-flow automated blood cell separator. Fenwal CS-3000, on blood coagulation and the fibrinolytic system in blood donors was studied. Blood samples were taken from the collection line of donors undergoing extracorporeal circulation, before and after platelet pheresis. Of the molecular markers, prothrombin fragment-F1 + 2 (PF1 + 2) markedly increased from 0.8 +/- 0.3 to 2.9 +/- 2.0 nM/ml (P < .004), thrombin antithrombin III complex (TAT) also markedly increased from 2.6 +/- 1.3 to 56.0 +/- 24.0 micrograms/L (P < .001), fibrinopeptide A (FPA) increased slightly from 0.8 +/- 0.9 to 3.8 +/- 4.2 micrograms/L (P < .05), and alpha 2-plasmin inhibitor (alpha 2-PI) decreased slightly from 95 +/- 8 to 91 +/- 9% (P < .05). In one donor with the highest level of PF1 + 2, TAT, FPA, and plasmin inhibitor complex after platelet pheresis, protein C, protein S, C4b-binding protein, ATIII, plasminogen, alpha 2-PI, and coagulation factors were decreased. In blood donors undergoing platelet pheresis using the continuous-flow automated blood cell separator, Fenwal CS-3000, a hypercoagulable state was observed. Changing the materials of the plastic disposables to a more thromboresistant material may prevent the hypercoagulable state in donors induced by platelet pheresis using the blood cell separator.

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“…'' 27) Furthermore, the brain generally has only low levels of fibrinolytic activity apart from the pituitary gland 33) and the meninges. 13,14,26) These factors may explain the present success in achieving hemostasis by adding fibrinogen to gelatin-thrombin matrix. Factor XIII also present in fibrin glue causes the fibrin to crosslink, which gives the coagulum additional resilience.…”

Section: Gelatin-thrombin Matrix In Cranial Neurosurgerymentioning

confidence: 99%

Use of Gelatin-Thrombin Matrix Hemostatic Sealant in Cranial Neurosurgery

Fiss

Danne

Stendel

2007

Neurol. Med. Chir.(Tokyo)

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The present study evaluated the hemostatic efficacy and handling of gelatin-thrombin matrix hemostatic sealant during intracranial procedures. A retrospective analysis of 478 consecutive patients undergoing intracranial procedures identified seven patients with acute intense or persistent intraoperative bleeding which could not be arrested in time by standard hemostatic methods. The efficacy of gelatinthrombin matrix was assessed by determining bleeding severity before and after application, time to hemostasis, amount of gelatin-thrombin matrix necessary, need for additional hemostatic measures, and need for reoperation to control hemorrhage. Immediate hemostasis was achieved in five of seven patients. Two of these five patients had abnormal clotting parameters. Cessation of bleeding was achieved by additionally applying either fibrinogen or gelatin sponge to the bleeding site in the other two patients. No complications attributable to gelatin-thrombin matrix use were recorded. The gelatinthrombin matrix was ready to use within 1 minute in every case. Gelatin-thrombin matrix appears to be an effective, easy-to-use, and readily available hemostatic agent for cranial neurosurgery. Combination with fibrinogen is recommended in special situations.

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The Treatment of Postperfusion Bleeding Using ε-Aminocaproic Acid, Cryoprecipitate, Fresh-Frozen Plasma, and Protamine Sulfate

Cited by 71 publications

References 12 publications

Changes in Blood Coagulation During and Following Cardiopulmonary Bypass:Lack of Correlation With Clinical Bleeding

Changes in Blood Coagulation During and Following Cardiopulmonary Bypass:Lack of Correlation With Clinical Bleeding

Hypercoagulable state induced by thrombocytapheresis

Use of Gelatin-Thrombin Matrix Hemostatic Sealant in Cranial Neurosurgery

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