Monitoring of fibrinolysis parameters during myocardial revascularization according to type of procedure

Abstract

The aim of the study was to assess the effect of cardiothoracic surgery on the dynamics of plasminogen, D-dimers and plasminogen activator inhibitor (PAI-I) during the first 24 h after surgery. The study included 14 patients operated with (on-pump) and 14 without (off-pump) the use of extracorporeal circulation (ECC). Blood sampling was carried out on induction of anesthesia (timepoint 1), on introduction of heparin (point 2) and protamine (point 3), at the end of surgery (point 4), and the next morning (point 5). Relative to point 1, the utilization of plasminogen at point 2 was 24% and 17% in the on-pump and off-pump groups, respectively (p=0.001 both). Increased D-dimer concentration from the baseline was more pronounced in the on-pump group (p=0.001). At point 5, D-dimer concentrations were comparable in both groups and different from baseline levels. PAI-I activity showed within-group differences from baseline at point 5 in the off-pump group (p=0.001), and at points 3 and 5 in the on-pump group (p=0.002 and 0.001, respectively). At point 5, the activity of PAI-I was comparable in both groups, yielding p=0.001 vs. baseline. Fibrinolysis was more pronounced and more dynamic in the on-pump group due to activation of the systemic inflammatory response induced by the use of ECC. In the off-pump group, fibrinolysis was a normal physiological response to the surgical procedure.

Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study

“…A comparison of minimally invasive closed circuit extracorporeal circulation with on-pump and off-pump bypass showed less perioperative activation of coagulation and fibrinolysis in patients undergoing off-pump surgery compared with that seen in patients undergoing on-pump surgery [21,22]. Other smaller studies have suggested comparable rather than disparate activation of the fibrinolytic system by on-pump and off-pump surgery [23,24]. Activation of fibrinolysis has been seen with extracorporeal circulation used during the course of valve replacement surgery [25].…”

D-dimers increase in acute ischemic stroke patients with the large artery occlusion, but do not depend on the time of artery recanalization

“…However, according to the authors knowledge, this is the first study assessing the relationship between the dynamics of D-dimer levels increase and the time to artery recanalization in ischemic stroke. Only Zivković et al [22] monitored D-dimer levels dynamics during myocardial revascularization according to type of procedure.…”