Early Activation of Hemostasis during Cardiopulmonary Bypass: Evidence for Thrombin Mediated Hyperfibrinolysis

H Teufelsbauer; Sylvia Proidl; M Havel; Th Vukovich

doi:10.1055/s-0038-1656358

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1992; 68(03): 250-252
DOI: 10.1055/s-0038-1656358

Original Article

Schattauer GmbH Stuttgart

Early Activation of Hemostasis during Cardiopulmonary Bypass: Evidence for Thrombin Mediated Hyperfibrinolysis

H Teufelsbauer

The Department of Medicine II, University of Vienna, Austria

,

Sylvia Proidl

The Department of Medicine II, University of Vienna, Austria

,

M Havel

¹The Department of Surgery II, University of Vienna, Austria

,

Th Vukovich

The Department of Medicine II, University of Vienna, Austria

› Author Affiliations

Abstract

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Summary

In 14 consecutive patients undergoing cardiopulmonary bypass for coronary bypass surgery the time course of coagulation and fibrinolysis markers were measured, e.g. plasma levels of thrombin-antithrombin III (TAT) complexes, cross-linked fibrin degradation products (X1FDP) and plasmin-α₂-antiplasmin complexes (PAP). TAT levels exceeded the 90% baseline percentile already during CPB (after opening of aortic clamp) in 10 patients, whereas PAP and X1FDP exceeded their 90% percentile in only one patient at this time. Concerning fibrinolysis markers PAP and X1FDP the majority of patients showed elevations higher than their 90% baseline percentile only 1 h postoperation. Correlation analysis revealed significant dependencies between TAT levels during and at the end of CPB and PAP levels 1 h postoperation (R = 0.55 and R = 0.56 respectively). Furthermore, 1 h postoperation X1FDP levels were significantly correlated with both TAT and PAP. Peak X1FDP levels at the same time correlated with blood loss via thoracic drains (R = 0.56). Thus, we suggest that hyperfibrinolysis in patients undergoing CPB is at least partly due to hypercoagulation. Clinically, this may implicate that intensified anticoagulation could prevent hyperfibrinolysis and reduce postoperative blood loss.

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References

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