The Influence of the Duration of Cardiopulmonary Bypass on Coagulation, Fibrinolysis and Platelet Function

Background: The duration of cardiopulmonary bypass (CPB) might influence blood coagulation. This appears particularly relevant in the light of new, less invasive techniques that propose smaller incisions at the expense of a possible prolongation of time on CPB. Methods: The time-dependent effects on coagulation, fibrinolysis and platelet function were investigated in 94 patients scheduled for elective coronary artery bypass grafting. Tests on coagulation, fibrinolysis, and platelet function (flow cytometric assay of expression densities of glycoprotein IIb/IIIa and P-selection were performed the day before surgery and after completion of surgery. Results: A significant correlation was found between the duration of CPB and parameters of increased coagulation, decrease of platelet counts during CPB and platelet function. Longer duration of CPB led to an increased need for transfusion of red blood cells. Conclusions: The duration of CPB affects thrombin formation as well as platelet count and function, but not the fibrinolytic system. This may prove to be a disadvantage when employing minimally invasive techniques that prolong the duration of CPB.

Key words:

Cardiopulmonary bypass - Haemostasis - Platelet function - Fibrinolysis - Coronary artery bypass grafting

References

• 1 Puskas J D, Wright C E, Ronson R S, Brown III W W, Gott J P, Guyton R A. Off-pump multivessel coronary bypass via sternotomy is safe and effective.  Ann Thorac Surg. 1998;  66 1068-72
• 2 Cooley D A. Minimally invasive valve surgery versus the conventional approach.  Ann Thorac Surg. 1998;  66 1101-1105
• 3 Despotis G J, Filos K S, Zoys T N, Hogue C W, Spitznagel E, Lappas D G. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients.  Anesth Analg. 1996;  82 13-21
• 4 Wahba A, Black G, Koksch M. et al . Aprotinin has no effect on platelet activation and adhesion during cardiopulmonary bypass.  Thrombosis and Haemostasis. 1996;  75 844-848
• 5 Schmitz G, Rothe G, Ruf A. et al . European Working Group on Clinical Cell Analysis: Consensus Protocol for the flow cytometric characterisation of platelet function.  Thromb Haemost. 1998;  79 885-96
• 6 Janes S L, Wilson D J, Cox A D. et al . ADP causes partial degranulation of platelets in the absence of aggregation.  Br J Haematol. 1994;  86 568-573
• 7 Lefkovits J, Plow E F, Topol E J. Platelet glycoprotein IIb/IIIa receptors in cardiovascular medicine.  N Engl J Med. 1995;  332 1553-1559
• 8 Addo J B, Bray P F, Grigoryev D. et al . Surface recruitment but not activation of integrin alpha IIb beta 3 (GPIIb-IIIa) requires a functional actin cytoskeleton.  Arterioscler Thromb Vasc Biol. 1995;  15 1466-1473
• 9 Michelson A D. Flow cytometry: A clinical test of platelet function.  Blood. 1996;  87 4925-4936
• 10 Kestin A S, Shukri C R, Loscalzo J. et al . The platelet function defect of cardiopulmonary bypass.  Blood. 1993;  82 107-117
• 11 Hunt B J, Parratt R N, Segal H C, Sheikh S, Kallis P, Yacoub M. Activation of coagulation and fibrinolysis during cardiothoracic operations.  Ann Thorac Surg. 1998;  65 712-718
• 12 Ereth M H, Nuttall G A, Oliver WC j r, Santrach P J, Price R D, Schaff H V. Temperature and duration of cardiopulmonary bypass influence transfusion requirements.  J Clin Anesth. 1998;  10 588-592
• 13 Kongsgaard U E, Smith-Erichsen N, Geiran O, Bjornskau L. Duration of cardiopulmonary bypass compared with changes in the plasma protease systems.  Scand J Thorac Cardiovasc Surg. 1991;  25 223-226
• 14 Harker L A, Malpass T W, Branson H E, Hessel II E A, Slichter S J. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective α-granule release.  Blood. 1980;  56 824-834