Centrifugal and roller pumps — are there differences in coagulation and fibrinolysis during and after cardiopulmonary bypass?

Abstract

A number of hemostatic parameters reflecting the activation of coagulation and fibrinolysis were investigated in a prospective study of 24 patients undergoing cardiopulmonary bypass (CPB) during heart surgery. The patients were randomized to a group in which either a roller (group 1) or a centrifugal pump (group 2) was used. Blood samples were taken preoperatively, at the onset of and every 20 min during CPB, after the administration of protamine, and 4, 20, 44, and 68 h postoperatively. The groups did not differ significantly in hematocrit, fibrinogen, factor XIII, and antithrombin III. Significant differences in favor of group 2 during and after CPB were found in prothrombin fragment F1 + 2, plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TAT), and D-dimer (F1 + 2 P < 0.01 after 80-min CPB, PAP P < 0.005 after 40-min CPB, TAT and D-dimer P < 0.05 after 100-min CPB, D-dimer and PAP P < 0.05 after protamine administration, TAT and F1 + 2 4 h after CPB). These findings indicate the activation of fibrinolysis preceding thrombin generation during cardiopulmonary bypass. In addition, we conclude that centrifugal blood pumping is beneficial in avoiding excessive activation of both coagulation and fibrinolysis.

Changes in coagulation and fibrinolytic parameters caused by extracorporeal circulation

“…Sternotomy seems to cause little activation of coagulation parameters, as only slight increases in the TAT and F1 + 2 concentrations could be observed. In addition, we could not confirm that the rise in TAT levels at the initiation of CPB was due to heparininduced activation of AT III, as speculated previously [13]. The second increase in TAT and F1 + 2 indicates enhanced coagulatory activity caused by CPB.…”

“…In earlier studies, we demonstrated a beneficial effect of the centrifugal pump compared to the roller pump regarding both activation of fibrinolysis and coagulation [13,22]. However, several problems remained unsolved.…”

“…Also, the serine protease inhibitor aprotinin, which inhibits plasmin and, at higher concentrations, kallikrein activity, is applied during CPB to reduce operative and postoperative bleeding [11,12]. However, alterations in coagulation and fibrinolysis can be observed during CPB, as described previously by our group [13,22] and other investigators [11,14]. The aim of the present consecutive study was to elucidate in more detail the effect of CPB on the activation of coagulation and fibrinolysis.…”

Reduced release of tissue factor by application of a centrifugal pump during cardiopulmonary bypass

“…Since clinical studies have suggested that the morbidity and occurrence of adverse events of CPB are associated with the degree of complement activation [9,10], the biocompatibitity of CPB has been assessed with the degree of complement activation. However, the importance of activation of coagulation [1,3] and of microembolization [11,12] during CPB has also been clearly demonstrated in several studies. Activation of coagulation during CPB may be caused either by contact activation (intrinsic pathway) or by tissue or blood cell damage (extrinsic pathway).…”

“…Cardiopulmonary bypass (CPB) leads to activation of coagulation and fibrinolysis [1][2][3] and the complement system [4,5], as well as of platelets [6] and teukocytes [7]. These humoral and cellular mechanisms result in the so-called post pump syndrome, with increased capillary permeability, damage of lung, kidney, liver, and neurological deficits [8].…”