Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass

Abstract

Aspirated blood contaminated by tissue contact is the most important activator of the coagulation system and the principal cause of hemolysis during cardiopulmonary bypass. Contact with a foreign surface is not a main variable in the procoagulant effect of bypass. Mimicking the outer cell membrane structure resulted in decreased platelet activation and decreased blood loss.

Retransfusion of pericardial blood does not trigger systemic coagulation during cardiopulmonary bypass

“…Initially, this activation was predominantly attributed to contact of blood with the body foreign surface of the extracorporeal bypass circuit of the heart lung machine [1]. More recently, smaller extracorporeal circuits and improved surface coatings have been developed with improved biocompatibility [2][3][4]. Despite these improvements, however, blood is still activated during the CPB.…”

“…Despite these improvements, however, blood is still activated during the CPB. For instance, the levels of prothrombin fragment F 1+2 (F 1+2 ) and thrombin-antithrombin complexes, which both reflect coagulation activation, increase in systemic blood during bypass [3][4][5][6][7][8][9][10][11][12]. These increases occur despite extensive heparinization, suggesting that systemic coagulation activation is incompletely blocked.…”

“…It is well established that pericardial blood is highly activated, including coagulation and fibrinolysis [3,4,[8][9][10][11][12][13]. In the literature, at least eight independent studies concluded that retransfusion of pericardial (wound) blood contributes to systemic coagulation activation [3,4,[7][8][9][10][11][12].…”

“…In the literature, at least eight independent studies concluded that retransfusion of pericardial (wound) blood contributes to systemic coagulation activation [3,4,[7][8][9][10][11][12]. Pericardial blood is retransfused to reduce the use of blood products, particularly in patients undergoing complex and prolonged heart surgery, whose volume of pericardial blood is too large to be discarded or to be processed by a cell saver [7,13].…”

Phosphorylcholine-coated extracoporeal circulation systems affect coagulation factors during cardiopulmonary bypass insufficiently: a preliminary report

“…[1,2] In recent years, reducing ECC-related adverse events and developing more physiological or hemocompatible ECC materials has taken much effort. [3,4] Improvements in surface modification and coating techniques with phosphorylcholine (PC) have been used to stop fibrinogen and protein adsorption as well as platelet collection and to inhibit the first step of activation of coagulation, thereby increasing the hemocompatibility of materials such as polytetrafluoroethylene (PTFE), polyethylene, polyurethane, silicone, and polyvinyl chloride (PVC) that are used in ECC circuits.…”