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

Teufelsbauer, H.; Proidl, Sylvia; Havel, Michael; Vukovich, Th.

doi:10.1055/s-0038-1656358

Cited by 76 publications

(36 citation statements)

References 18 publications

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“…However, the assumption by Iberti, et al, [2] of a postoperative hypercoagulation is confirmed by our study because marked intraoperative activation of coagulation and fibrinolysis was evident from the dramatic increase in D-dimer levels in patients with glioma or meningiomas. Compared with patients undergoing coronary bypass surgery involving the extracorporeal circulation, in which hemostasis activation is commonly considered to be a serious complication, [8] the levels of D-dimer commonly found in our patients far surpass those of bypass patients (preoperative to postoperative levels in coronary bypass patients = X 3.4, patients with glioma X 10, and patients harboring meningioma X 20). Furthermore, our patients with glioma or meningioma showed a biphasic decline in D-dimers postoperatively; the first halving of levels occurred within 24 hours (from Day 1 to 2 postoperatively) the next halving lasted for more than 5 days.…”

Section: Discussionmentioning

confidence: 66%

Hemostasis activation in patients undergoing brain tumor surgery

Vukovich

Gabriel²,

Schaefer³

et al. 1997

FOC

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Patients undergoing brain tumor surgery are at high risk for the occurrence of a thromboembolic event. To identify a laboratory marker suitable for risk estimation the authors studied the perioperative time pattern of routine coagulation parameters and the specific hemostasis activation marker D-dimer in 28 consecutive patients at high risk (11 patients with glioma and eight patients with menigioma) and low risk (9 patients with metastases) for thromboembolism, as previously reported. As is typical during major surgery, most of the routine parameters declined, probably because of hemodilution, and recovered postoperatively to values higher than baseline, probably because of an acute-phase reaction. On Days 2 and 7 after surgery no difference in the routine parameters was recorded between patients at high (meningioma and glioma) and low risk (metastases). The level of D-dimer was elevated at baseline in patients with metastases, indicating a hemostatic hyperactivity that is usual in cancer patients. During surgery a marked increase in D-dimer levels occurred in patients with meningioma and glioma (pre- and postoperative median 90/2000 and 100/1020 ng/ml, respectively), but the increase was less pronounced in patients with metastases (320/660 ng/ml). Postoperatively, D-dimer declined in patients with metastases to lower levels than preoperatively (Day 7, 270 ng/ml); in patients with meningioma or glioma, however, D-dimer levels remained elevated until Day 7 (450 and 200 ng/ml). These results indicate that levels of D-dimer correlate with the reported high risk for thromboembolism in patients with meningioma and glioma, and D-dimer should be evaluated for its use in estimating individual risk and the efficiency of its use in the control of prophylactic treatment.

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Section: Discussionmentioning

confidence: 66%

Hemostasis activation in patients undergoing brain tumor surgery

Vukovich

Gabriel²,

Schaefer³

et al. 1997

FOC

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“…A literatura nos mostra que, durante grandes cirurgias abdominais, cardíacas, ginecológicas, urológicas e de tumores cerebrais, há ativação da coagulação e consequente ativação secundária do sistema fibrinolítico [19][20][21][22][23][24] . Isto pode ser evidenciado no Caso 1, pelo encontro de moderado aumento nos produtos de degradação do fibrinogênio e fibrina (PDF).…”

Section: Discussionunclassified

Hematoma epidural espontâneo: relato de dois casos

Hamamoto

Nakano

Guerreiro

et al. 1998

Arq. Neuro-Psiquiatr.

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RESUMO -Os hematomas epidurais espontâneos são raramente descritos na literatura. Estão associados a doenças infecciosas do crânio, distúrbios da coagulação, malformações vasculares da dura-máter e metástases na calota craniana. Os autores relatam dois casos de hematomas epidurais espontâneos de diferentes etiologias e discutem aspectos relacionados à hemostasia.PALAVRAS-CHAVE: hematoma epidural, hematoma espontâneo, hemostasia. Spontaneous epidural hematoma: report of two casesABSTRACT -Spontaneous epidural hematomas are rarely described in literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura-mater and metastasis to the skull. The authors report two cases of spontaneous epidural hematoma of different etiologies, and study parameters of hemostasis.KEY WORDS: epidural hematoma, spontaneous hematoma, hemostasis.Os hematomas epidurais (HED) são considerados lesões secundárias a traumatismo craniencefálico e sua incidência varia de 0,2 a 30% de acordo com a literatura 1-3 . Cerca de 83 a 95% dos casos estão associados a fraturas de crânio 2-5 ; porém, quando não há história ou sinais de traumatismo e na ausência de fraturas de crânio, pode-se dizer que o HED ocorreu espontaneamente 5 . Alguns casos de HED espontâneo têm sido relatados, associados a doenças infecciosas (sinusites e otite média aguda) 5-11 , malformações vasculares da dura-máter 5,12,13 , distúrbios da coagulação 14,15 e metástases na calota craniana 16 . Neste artigo apresentamos dois casos de HED espontâneo, um deles associado a distúrbios da coagulação e o outro a pansinusite. Aspectos etiológicos dos HED espontâneos são discutidos. RELATO DOS CASOSCaso 1 -LA, 12 anos, sexo feminino, com insuficiência renal crônica devida a infecções urinárias de repetição, por bexiga neurogênica secundária a mielomeningocele corrigida no primeiro dia de vida. Foi submetida a transplante renal, houve moderada perda sanguínea, recebendo cerca de 400 ml de concentrado de hemácias no intra-operatório. Após o transplante foi mantida em UTI; no 3º dia pós-operatório, sem qualquer história de trauma, tornou-se irritadiça com cefaléia intensa na região parietal direita.

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“…Thrombin is one of several proteolytic enzymes that are generated during CPB. This thrombin generation occurs in spite of apparently adequate heparin [16,17,29,196]. The proteolytic substances generated by CPB exert their effects on membrane receptors (cellular phase) and on circulating proteins (humoral phase) with resultant amplification of harmful effects.…”

Section: Thrombin and Cardiopulmonary Bypassmentioning

confidence: 99%

Thrombin and cardiopulmonary bypass – A paradigm for evaluation of the regulation of hemostasis

Ferraris

2011

Int J Angiol

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Extracorporeal circulation for the purpose of cardiopulmonary bypass (CPB) is used extensively for repair of cardiac defects. Complex mechanisms, many of which involve the generation of thrombin, are initiated by the institution of CPB. Thrombin is generated during CPB in spite of high doses of heparin. The tissue factor/ factor VII pathway is also activated and is probably responsible for generation of most of the thrombin seen during CPB. Plasma proteins (humoral phase) along with platelets, endothelium and white cells (cellular phase) are also activated by contact of blood with synthetic surfaces. Small amounts of thrombin activate endothelial cells which then generate tissue plasminogen activator (t-PA). Plasmin is generated by the action of t-PA and fibrinolysis ensues. The blood becomes a mix of vasoactive substances that alter vascular smooth muscle tone and endothelial cell contraction. The sum of these reactions is called the Ôwhole body inflammatory responseÕ and is responsible for postoperative morbidity including bleeding and organ system dysfunction.Attempts to control the morbidity of CPB have focused on reversible inhibitors of some of the reactions described above. Potentially helpful new strategies may include: 1) enhanced production of thrombin-activatable fibrinolysis inhibitor (TAFI) to limit fibrinolysis, 2) synthesis of thrombin receptor blockers to limit platelet and endothelial activation, 3) protection of endothelial cell receptors during CPB, 4) control of CPB-induced platelet-PMN and endothelial-PMN adhesion in order to limit postoperative organ system dysfunction, and 5) limitation of tissue factor pathway activation in order to minimize thrombin production during CPB. This review highlights recent developments in the understanding of the molecular mechanisms of the action of thrombin induced by CPB.

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

Cited by 76 publications

References 18 publications

Hemostasis activation in patients undergoing brain tumor surgery

Hemostasis activation in patients undergoing brain tumor surgery

Hematoma epidural espontâneo: relato de dois casos

Thrombin and cardiopulmonary bypass – A paradigm for evaluation of the regulation of hemostasis

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