Postoperative Bleeding in Cardiac Surgery

Iribarren, J; Jiménez, Juan J.; Hernández, Domingo; Brouard, M; Riverol, Debora; Lorente, Leonardo; Llana, Ramiro de la; Nassar, Ibrahim; Pérez, R; Martínez, Rafael; Mora, María L.

doi:10.1097/aln.0b013e318167aecc

Cited by 25 publications

(8 citation statements)

References 21 publications

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“…PAI-1 gene polymorphism determined predisposition to a higher vagus tone in 5G allele carriers through the increase of the number of platelets. The PAI-1 gene ( -675 4G/5G ) polymorphism influences the plasma levels of PAI-1, which is considered a regulator of fibrinolysis; 5G/5G carriers demonstrated a lower level of PAI-1, greater postoperative bleeding and blood loss compared to other variants 40 41 . Thus, increased vagus tone, along with platelet count in 5G allele carriers, may be considered a compensation or resilience mechanism, i.e., increased vagus pro-coagulation activity in these subjects compensates for their predisposition to extensive bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Sport activity and polymorphism of the Factor 12 gene were found to have independent effects on vagus tone that suggest the probability of an indirect modification of this gene effect by regular physical activity. However, sport activity directly modifies other genetic effects on vagus reactivity by increasing it in non- C allele carriers of the MTHFR gene and in 5G -allele carriers of the PAI-1 gene, most likely through epigenetic mechanisms, which may heighten the pro-coagulation bias determined by hyperhomocysteinemia in the former group of subjects 39 , but compensate for the coagulation deficit in the latter group of subjects 40 41 . An additional gene-gene interaction effect was also detected.…”

Section: Discussionmentioning

confidence: 99%

“…Higher platelet number, lower mean platelet volume and genetic polymorphisms (e.g., in C -allele carriers of the Factor 12 gene 38 and non- C -allele carriers of the MTHFR gene 39 ) that are associated with higher pro-coagulation effects are also associated with higher vagus activity. In the case of PAI-1 polymorphism (anti-fibrinolytic factor), the correspondence between two indicators of high pro-coagulation activity (high platelet number and high power of HF-HRV) in 5G/5G carriers of the PAI-1 gene (having decreased suppression of fibrinolysis 40 41 ) permits considering the pattern as a part of a physiological mechanism that protect those with this genotype against extensive bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms

Davydov

Жданов

Двоеносов

et al. 2015

Sci Rep

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A major challenge presently is not only to identify the genetic polymorphisms increasing risk to diseases, but to also find out factors and mechanisms, which can counteract a risk genotype by developing a resilient phenotype. The objective of this study was to examine acquired and innate vagal mechanisms that protect against physical challenges and haemorrhages in 19 athletes and 61 non-athletes. These include examining change in heart rate variability (HF-HRV; an indicator of vagus activity) in response to orthostatic challenge, platelet count (PLT), mean platelet volume (MPV), and single-nucleotide polymorphisms in genes that encode several coagulation factors, PAI-1, and MTHFR. Individual differences in PLT and MPV were significant predictors, with opposite effects, of the profiles of the HF-HRV changes in response to orthostasis. Regular physical training of athletes indirectly (through MPV) modifies the genetic predisposing effects of some haemostatic factors (PAI-1 and MTHFR) on vagal tone and reactivity. Individual differences in vagal tone were also associated with relationships between Factor 12 C46T and Factor 11 C22771T genes polymorphisms. This study showed that genetic predispositions for coagulation are modifiable. Its potential significance is promoting advanced protection against haemorrhages in a variety of traumas and injuries, especially in individuals with coagulation deficits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms

Davydov

Жданов

Двоеносов

et al. 2015

Sci Rep

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“…Several recent studies have described the influence of genetic factors, such as PAI-1 promoter – 675 (4G/5G) polymorphism, on the plasma levels of PAI-1, t-PA and t-PA/PAI-1 complex [1,4,6,17-20]. The 5G allele is associated with low levels of PAI-1 [4,6,17,19]. …”

Section: Discussionmentioning

confidence: 99%

“…These include the surgery per se as well as effects of the cardiopulmonary bypass (CPB) on the coagulation and the inflammation cascades, and their cross-reactions with the fibrinolytic – and the kinin-kallikrein systems [1-3]. During the last few years, increasing attention has been paid to reports demonstrating the influence of the fibrinolytic system on increased bleeding, particularly after cardiac surgery employing CPB [1,4-6]. …”

Section: Introductionmentioning

confidence: 99%

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

et al. 2012

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BackgroundEnhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor – 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding.MethodsTotally 88 adult patients (mean age 66 ± 10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ≤ 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS.ResultsNine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = − 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P < 0.001 and P = 0.012, respectively). Group I displayed significantly lower plasma concentrations of fibrinogen and higher levels of D-dimer from immediately after the operation and throughout the first 24 hours postoperatively.ConclusionsLower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery.

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Impact of genetic variation on perioperative bleeding

Muehlschlegel

Body

2008

American J Hematol

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Variation in bleeding in the perioperative period is a complex and multifactorial event associated with immediate and delayed consequences for the patient and health care resources. Little is known about the complex genetic influences on perioperative bleeding. With the discovery of multiple variations in the human genome and ever-growing databases of well-phenotyped surgical patients, better identification of patients at risk of bleeding is becoming a reality. In this review, polymorphisms in the platelet receptor genes, plasminogen activator inhibitor, and angiotensin genes among others will be discussed. We will explore the nature, effects, and implications of the genetics that influence perioperative bleeding above and beyond surgical bleeding, particularly in cardiac surgery.

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Postoperative Bleeding in Cardiac Surgery

Abstract: Plasminogen activator inhibitor-1 5G/5G homozygotes who did not receive TA showed significantly greater postoperative bleeding than patients with other PAI-1 genotypes. 5G/5G homozygotes who received TA showed the greatest blood-sparing benefit.

Cited by 25 publications

References 21 publications

Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms

Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

Impact of genetic variation on perioperative bleeding

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