Activation of Coagulation and Fibrinolysis During Cardiothoracic Operations

Hunt, Beverley J.; Parratt, Rachel; Segal, Helen; Sheikh, Sajila; Kallis, P; Yacoub, Magdi H.

doi:10.1016/s0003-4975(97)01345-3

Cited by 150 publications

(86 citation statements)

References 21 publications

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“…In our study, the D-dimer level was higher than the reported level in liver cirrhosis patients after portal hypertension surgery, measured at similar sensitivity conditions, but had a lower specificity than the reported one. This may be attributed to the hyperactive state of the coagulation pathway due to the high coagulability state in liver cirrhosis patients, activated fibrinolysis, blood products used perioperatively, and trauma due to surgery [20][21][22]30] . Dynamic D-dimer value monitoring during the early stages after portal hypertension surgery may be more useful in achieving a meaningful diagnosis of PVT due to thrombosis formation.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis

Deng¹,

Liu²,

Fang³

et al. 2007

WJG

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AIM:To evaluate the predictive value of D-dimer as a predictive indicator of portal vein thrombosis (PVT) after portal hypertension surgery in hepatitis B virus-related cirrhosis. METHODS:A prospective study was carried out in 52 patients who had undergone surgery for portal hypertension in hepatitis B virus-related cirrhosis. Changes in perioperative dynamic D-dimer were observed. The sensitivity, specificity, positive predictive values and negative predictive values of D-dimer were calculated, and ROC curves were analyzed. RESULTS:The D-dimer levels in the group developing postoperative PVT was significantly higher than those in the group not developing PVT (P = 0.001), and the ROC semi-quantitative and qualitative analysis of D-dimer showed a moderate predictive value in PVT (semiquantitative value Az = 0.794, P = 0.000; qualitative analysis: Az = 0.739, P = 0.001). CONCLUSION:Dynamic monitoring of D-dimer levels in patients with portal hypertension after surgery can help early diagnosis of PVT, as in cases where the D-dimer levels steadily increase and exceed 16 µg/mL, the possibility of PVT is very high.

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Section: Discussionmentioning

confidence: 99%

Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis

Deng¹,

Liu²,

Fang³

et al. 2007

WJG

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“…The vascular model used in this study is a modification of previous models that were used to assess changes in fibrinolytic marker levels and to evaluate the effect massive blood loss has on fibrinolysis during liver transplantation. [8][9][10][11] As a clinical problem we chose to study coagulation during cardiopulmonary bypass (CPB) for several reasons: (1) CPB results in a reproducible stimulation of coagulation that can be used to study the regulation of this system, 12 (2) CPB is an important clinical tool used in the treatment of heart disease that still has significant risk and side effects associated with it, and (3) many new drugs (such as aprotinin) and technologies (such as heparin-coated bypass circuits) are being developed and used to reduce hemostatic activation and side effects, even though their precise mechanism of action is still debated. 13 The long range goal is to use this method of analysis to better understand the regulation of the hemostatic system and to hopefully suggest which new therapies are likely to be the most effective in preventing, suppressing, or eliminating hemostatic disorders.…”

Section: Introductionmentioning

confidence: 99%

Estimating the rate of thrombin and fibrin generation in vivo during cardiopulmonary bypass

Chandler

Velan

2003

Blood

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Our objective was to estimate the in vivo rates of thrombin and fibrin generation to better understand how coagulation is regulated. Studied were 9 males undergoing cardiopulmonary bypass (CPB). The rates of thrombin, total fibrin, and soluble fibrin generation in vivo were based on measured levels of prothrombin activation peptide F1.2, thrombin-antithrombin complex, fibrinopeptide A, and soluble fibrin, combined with a computer model of the patient's vascular system that accounted for marker clearance, hemodilution, blood loss, and transfusion. Prior to surgery, the average thrombin generation rate was 0.24 ؎ 0.11 pmol/s. Each thrombin molecule in turn generated about 100 fibrin molecules, of which 1% was soluble fibrin. The thrombin generation rate did not change after sternotomy or administration of heparin, then rapidly increased 20-fold to 5.60 ؎ 6.65 pmol/s after 5 minutes of CPB (P ‫؍‬ .000 05). Early in CPB each new thrombin generated only 4 fibrin molecules, of which 35% was soluble fibrin. The thrombin generation rate was 2.14 ؎ 1.88 pmol/s during the remainder of CPB, increasing again to 5.47 ؎ 4.08 pmol/s after reperfusion of the ischemic heart (P ‫؍‬ .000 08). After heparin neutralization with protamine, thrombin generation remained high (5.34 ؎ 4.01 pmol/s, P ‫؍‬ .0002) and total fibrin generation increased, while soluble fibrin generation decreased. By 2 hours after surgery, thrombin and fibrin generation rates were returning to baseline levels. We conclude that cardiopulmonary bypass and reperfusion of the ischemic heart results in bursts of nonhemostatic thrombin generation and dysregulated fibrin formation, not just a steady increase in thrombin generation as suggested by previous studies.

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“…In case of surgery in which massive blood loss is expected or can be sudden, a machine for recuperation of blood -a cell-saver is advocated 4 . Cell-saver machines enable processing the blood removed by suction and to return it to the patient's circulation despite impact on coagulation 5,6 . The filters of cell-savers can remove large particles as fat or tissue but cannot delete tissue factor and other cytokines released due to surgical trauma and affecting coagulation 7 .…”

Section: Discussionmentioning

confidence: 99%

Impact of retransfusion of blood processed in cell-saver on coagulation versus cardiopulmonary bypass: A prospective observational study using thromboelastography

Vymazal¹,

Filaun²,

Horáček³

2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims.To compare an impact of retransfusion of blood processed in cell-saver (CS) with that of cardiopulmonary bypass (CPB) on blood coagulation in patients undergoing cardiac surgery. Methods. Prospective observational study using thromboelastography (TEG). Results. TEG samples from 170 patients were analyzed. Cardiopulmonary bypass was used in 100 patients while 70 patients were operated off-pump. In 20 off-pump patients collected blood was processed by cell-saver and returned. In all patients clot formation after heparin neutralization by protamine was unimpaired. However, there was a significant increase in fibrinolysis defined by the TEG parameter Lysis time 30 min after the maximum amplitude of the clot was reached (Ly30) in groups with CPB or CS but this increase still did not exceed the threshold for clinical fibrinolysis (Ly30 > 7.5%). In the group without CPB there was no significant impact on coagulation. Conclusion. Surgery that avoids CPB and/or CS is the gentlest method for inducing blood coagulation.

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Activation of Coagulation and Fibrinolysis During Cardiothoracic Operations

Cited by 150 publications

References 21 publications

Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis

Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis

Estimating the rate of thrombin and fibrin generation in vivo during cardiopulmonary bypass

Impact of retransfusion of blood processed in cell-saver on coagulation versus cardiopulmonary bypass: A prospective observational study using thromboelastography

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