Tissue Factor Is Rapidly Elevated in Plasma Collected from the Pericardial Cavity during Cardiopulmonary Bypass

Abstract

SummaryThere is growing evidence that the tissue factor/factor VIIa pathway of coagulation is enhanced during cardiopulmonary bypass. Hitherto, available evidence has suggested that upregulated monocyte bound tissue factor is made available, either in the blood collected from the site of surgery or on circulating cells. However, cellular upregulation is slow, while generation of factor VIIa in blood collected from the pericardial cavity is rapid. We have therefore investigated the possibility of an alternative source of tissue factor, plasma (as opposed to cellular) tissue factor in blood samples taken from the central vein catheter (systemic circulation) and collected from the pericardial cavity during cardiopulmonary bypass. Six patients undergoing first time cardiopulmonary bypass grafting were studied. Tissue factor antigen was found to be rapidly elevated (by 15 min) in the pericardial plasma, ∼5-fold above systemic levels (p <0.004). Similar elevations were found in markers of coagulation activation, factor VIIa antigen (p = 0.066), prothrombin fragment F1+2 (p <0.003) and thrombin-antithrombin complex (p <0.03). To explore whether plasma tissue factor was (or had been) functionally active, factor VIIa was measured also with the soluble tissue factor functional assay after removal of heparin. Functional factor VIIa activity fell significantly in the systemic circulation, probably due to the heparin-induced increase (∼15-fold) in tissue factor pathway inhibitor (TFPI), but was elevated in pericardial blood compared with that taken from the central line catheter (p <0.006). These results demonstrate that both components of the activation complex for the extrinsic pathway of coagulation are rapidly generated in pericardial blood during bypass.

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

“…This is in line with previous studies by us and others [3,4,[8][9][10][11][12][13]. In addition, we showed that systemic concentrations of F 1+2 only increase during bypass in patients who receive retransfused pericardial blood.…”

“…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].…”

Quantitative and Temporal Differences in Coagulation, Fibrinolysis and Platelet Activation after On-Pump and Off-Pump Coronary Artery Bypass Surgery

“…The activation of factor VII by tissue factor is the initial step in the tissue factor pathway activation of the coagulation cascade [15]. Tissue factor binds with factor VIIa, stabilising the active site of factor VIIa.…”

Η Επίδραση Της Στρατηγικής Περιορισμού Των Ενδοφλεβίως Χορηγούμενων Υγρών Στον Αριθμό Των Μεταγγιζόμενων Μονάδων Συμπυκνωμένων Ερυθρών Στις Καρδιοχειρουργικές Επεμβάσεις Με Εξωσωματική Κυκλοφορία

“…Η έγχυση του µεσοθωρακικού αίµατος έχει σαν αποτέλεσµα την ενεργοποίηση της εξωγενούς οδού της πήξης [583,695,706], αν και η έκπλυσή του µπορεί να µειώσει αυτές τις ανωµαλίες [648,704]. Επιπλέον, το µεσοθωρακικό αίµα περιέχει µόρια λίπους και θροµβοέµβολα που δεν έχουν εντελώς αποµακρυνθεί από τα υπάρχοντα φίλτρα, και αυτές οι "προσµίξεις" έχουν ενοχοποιηθεί για τυχόν νευρολογική δυσλειτουργία µετά από καρδιοχειρουργική επέµβαση [432,707,708]. Η χρήση µιας συσκευής κυτταρικού διαχωριστή για έκπλυση του µεσοθωρακικού αίµατος έχει σαν αποτέλεσµα µια σηµαντική µείωση στα λιπώδη έµβολα και στις φλεγµονώδεις κυτοκίνες στο επαναχορηγούµενο αίµα σε σύγκριση µε το αίµα που λαµβάνεται απευθείας από την αναρρόφηση της καρδιοτοµίας [648,704,709].…”