Individual Variations in the Fibrinolytic Response During and After Cardiopulmonary Bypass

W L Chandler; J C K Fitch; M H Wall; E D Verrier; R P Cochran; L O Soltow; B D Spiess

doi:10.1055/s-0038-1649929

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1995; 74(05): 1293-1297
DOI: 10.1055/s-0038-1649929

Original Article

Fibrinolysis

Schattauer GmbH Stuttgart

Individual Variations in the Fibrinolytic Response During and After Cardiopulmonary Bypass

Authors

W L Chandler

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA
J C K Fitch

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA
M H Wall

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA
E D Verrier

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA
R P Cochran

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA
L O Soltow

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA
B D Spiess

The Departments of Laboratory Medicine, Anesthesiology and the Cardiovascular Surgery Division of the Department of Surgery at the University of Washington, Seattle, Washington, USA

Abstract

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Summary

The purpose of this study was to determine whether individual patients show different patterns of fibrinolytic response to cardiopulmonary bypass (CPB) and whether preoperative or intraoperative parameters were predictive of these different patterns. Active t-PA, active PAI-1 and total t-PA antigen were measured in plasma samples obtained from 38 subjects, age 32 to 85 (median 69 years), before, during and after CPB. Four patterns of fibrinolytic response were noted: 1) 40% of patients showed the “typical” response, a rapid rise in active and total t-PA during CPB followed postoperatively by elevated PAI-I and reduced t-PA, 2) 10% showed no change in t-PA or PAI-1 during or after CPB, 3) 24% showed no change in t-PA with an increase in PAI-1 postoperatively, and 4) 26% showed an increase in t-PA during CPB with no change in PAI-1 postoperatively. When present, the t-PA response was rapid, occurring within the first 30 min of CPB and was more common in patients undergoing valve surgery than in coronary artery bypass grafting (p <0.005). Increased levels of PAI-1 postoperatively were associated with ischemic times greater than 70 min (p = 0.003) but not with the total length of CPB. Age, sex, CPB temperature, total CPB time and preoperative levels of t-PA and PAI-1 were not associated in the intra- or postoperative fibrinolytic response pattern. We conclude that the fibrinolytic response to CPB is heterogeneous. Further studies will be needed to determine whether different response patterns are clinically significant.

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References

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