Heparin causes platelet dysfunction and induces fibrinolysis before cardiopulmonary bypass

Khuri, Shukri F.; Valeri, C. R.; Loscalzo, Joseph; Weinstein, Mark J.; Birjiniuk, Vladimir; Healey, Nancy A.; Macgregor, H.; Doursounian, Mheir; Zolkewitz, Michael A.

doi:10.1016/0003-4975(95)00668-b

Cited by 174 publications

(76 citation statements)

References 20 publications

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“…Setting: Clinical investigation on a surgical and neurosurgical intensive care unit in a university hospital. Patients: The study included 45 patients: 15 postoperative with patients sepsis (Acute Physiology and Chronic Health Evaluation II score between 15 and 25), 15 trauma patients (Injury Severity Score 15 to 25), and 15 neurosurgical patients. Interventions: Management of the patients was carried out according to the guidelines for modern intensive care therapy.…”

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confidence: 99%

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

et al. 1997

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confidence: 99%

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

et al. 1997

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“…The children in this group had median sternotomies and had two or more chest drains present at the time of therapy, and would all have had oedematous, and therefore potentially friable, chest wall tissue. In addition, an increased bleeding tendency is an inevitable consequence of the abnormal platelet function and increased fibrinolysis following heparinisation and cardiopulmonary bypass [8]. The children presented here did not experience any increase in chest drain losses or any localised bleeding at points of contact between the cuirass and the chest wall during the period of NPV.…”

Section: Discussionmentioning

confidence: 77%

Negative pressure ventilation as haemodynamic rescue following surgery for congenital heart disease

et al. 2000

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A low cardiac output state is an important cause of morbidity and mortality following repair of tetralogy of Fallot (ToF). This is often refractory to conventional measures. The cardiac output of these patients is highly dependent on diastolic pulmonary arterial flow which is enhanced during spontaneous respiration, but much reduced by intermittent positive pressure ventilation (IPPV). We report the successful use of negative pressure ventilation (NPV) as haemodynamic therapy in three children with a low output secondary to restrictive right ventricular (RV) physiology following ToF repair. NPV produced a significant haemodynamic improvement, with increases in cardiac output of greater than 100 % in two of the children. By augmenting pulmonary blood flow, and hence cardiac output, NPV has a role as adjunctive haemodynamic therapy in patients with a low output secondary to diastolic RV dysfunction, in whom early extubation is not possible.

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“…Various studies have shown different results in the expression of the platelet receptors (CD41a, CD42b, and CD62P) with relation to different clinical settings during CPB (8,25,(31)(32)(33). Literature reviews report that various doses of methylprednisolone (1-30 mg/kg) have been used during CPB for the past 30 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, analysis of other fibrinolysis factors such as α 2 antiplasmin complex tPA-PAI-1 that could play a role in reducing bleeding is recommended. While some studies have argued that CPB would affect expression of platelet surface receptors such as GP Ib (CD42b), GP IIb-IIIa (CD41a-CD61), or GMP140 (CD62-P) (8,25), others have postulated that extrinsic factors such as the oxygenator, hypothermia, hemodilution, and heparin are involved in platelet dysfunction (29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

The effect of methylprednisolone treatment on fibrinolysis, thecoagulation system, and blood loss in cardiac surgery

Ebrahimi¹,

Kheirandish²,

Foroughi³

2016

Turk J Med Sci

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Background/aim: The purpose of this study was to examine steroid pretreatment in order to decrease postoperative coagulopathy disorders and bleeding. Materials and methods:In this randomized double-blinded study, the efficacy of low versus high doses of methylprednisolone on the coagulation system and postoperative bleeding was compared in patients who were undergoing cardiac surgery with cardiopulmonary bypass (CPB). The platelet response to agonists, D-dimer concentration, tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1) antigens, and platelet receptors CD42b, CD62P, and CD41a were evaluated. Results:The platelet response to agonists was reduced. The mean concentrations of D-dimer and tPA antigen increased although PAI-1 concentration did not show any significant changes following heparin neutralization. Postoperative expression of CD42b showed no changes in comparison with preoperation values in both groups. There was a significant increase in the expression of CD62P with a methylprednisolone dose of 15 mg/kg, while there was just a slight increase with a dose of 5 mg/kg. CD41a, as a fibrinogen receptor, was increased significantly after CPB in both groups. Significant data were shown in decreasing blood loss with a high dose of methylprednisolone. Conclusion:Methylprednisolone at a dose of 15 mg/kg reduced bleeding, probably by increasing CD62P after heparin neutralization, which can activate platelet activation in favor of better hemostasis.

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Heparin causes platelet dysfunction and induces fibrinolysis before cardiopulmonary bypass

Cited by 174 publications

References 20 publications

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

Negative pressure ventilation as haemodynamic rescue following surgery for congenital heart disease

The effect of methylprednisolone treatment on fibrinolysis, thecoagulation system, and blood loss in cardiac surgery

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