Intra- and Postoperative Fibrinolysis in Patients Undergoing Cardiopulmonary Bypass Surgery

Abstract

The influence of cardiopulmonary bypass (CPB) on fibrinolytic activity was assessed in 100 patients with valvular heart disease or atrial septal defects. Euglobulin fibrinolytic activity (EFA), tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor 1 (PAI-1) activity, plasminogen, α₂-antiplasmin (α₂-AP), fibrinogen degradation products (FDP), and D-dimer were measured pre-, intra-, and postoperatively. There were significant increases in EFA and t-PA activity (p < 0.002), and decreases in plasminogen and α₂-AP (p < 0.0001) intraoperatively with respect to baseline values. t-PA activity decreased significantly after surgery (p < 0.002), whereas PAI-1 activity showed a marked increase shortly after operation and on postoperative day 1 (p < 0.0001). FDP and D-dimer levels were significantly increased both intra- and postoperatively, the latter showing higher values (p < 0.01 and p < 0.0001, respectively). This study shows that there is an activation of the fibrinolytic system, as a result of the increased activation of plasminogen and decreased levels of plasmin inhibitors, during CPB surgery followed by a postoperative fibrinolytic shutdown.

Phosphorylcholine-coated extracoporeal circulation systems affect coagulation factors during cardiopulmonary bypass insufficiently: a preliminary report

“…Cardiopulmonary bypass-associated fibrinolysis frequently emerges after a rapid rise in D-dimer levels after neutralizing the effect of heparin. [14] Like the study by Páramo et al [15] the D-dimer levels in our groups increased significantly during CPB and reached their peak after the administration of protamine.…”

Safety of Intra-Arterial Thrombolysis in the Postoperative Period

“…Dysfunctional platelets have been described before in patients after CABG and could account for a hemorrhagic tendency. 11 It is noteworthy that the IAT was performed on the first day after CABG, whereas most cases of post-CABG IAT reported in the literature have been later. 4 Clot-bound fibrin in the hyperacute postoperative period may be less well polymerized and may pose a higher risk.…”

Recent Surgery or Invasive Procedures and the Risk of Stroke

“…Studies addressing the temporal relationship between intervention and stroke reported that only a minority of strokes occur even during the surgery but far more during the post-interventional period [1]. Pathogenic mechanisms potentially linking surgery to stroke may include perioperative interruption of anticoagulant, antiplatelet, and other medication, infections, and cardiac complications like induction of atrial fibrillation (AF), intraoperative hypotension, and perioperative hypercoagulopathy [1,2,10]. …”