The haemostatic defect following extracorporeal circulation

Excess intravascular coagulation complicating low cardiac output.

“…The vogue for prophylactic fibrinolytic blockade with EACA has passed (Porter and Silver, 1968) but there is uncertainty over the potential value of coagulation factor and platelet concentrates and of heparin. A coagulation profile performed serially during and after bypass has previously been used to study the haemostatic defect (Porter and Silver, 1968;Douglas, McNicol, Bain, and Mackey, 1966;Thurnherr, 1967;Gralnick and Fischer, 1971). These profiles have been performed on heterogeneous groups of patients comprising congenital and acquired heart defects, children and adults, and cyanotic and acyanotic patients.…”

“…Factor VIII levels show minor changes only (Gralnick and Fischer, 1971) while fibrinogen shows a small reduction (Gralnick and Fischer, 1971) followed by rapid correction (Thurnherr, 1967;Porter and Silver, 1968) and a subsequent rebound to supranormal levels (Thurnherr, 1967;Porter and Silver, 1968;Boyd, Engelman, Beaudet, and Lackner, 1972). Factor V levels fall further, and are still reduced by 30% in the first few postoperative hours (Douglas et al, 1966;Thurnherr, 1967;Porter and Silver, 1968;Gralnick and Fischer, 1971), but only occasionally fall to a level which may contribute to excessive bleeding (Gralnick and Fischer, 1971). The increased fibrinolytic activity associated with bypass also corrects spontaneously within a few hours (Thurnherr, 1967;Porter and Silver, 1968;Gralnick and Fischer, 1971) unless there is a defect in the bypass technique (Brooks and Bahnson, 1972).…”

Fibrinolysis during Extracorporeal Circulation

“…After protamine sulfate neutralization of heparin, blood was allowed to clot for 1 to 3 hours at 37°C, the serum was separated by centrifugation, and 10 units of thrombin were added. All heparinized samples of platelet-poor plasma were neutralized with protamine sulfate using the method described by Douglas et al (2). Serum and neutralized platelet-poor plasma were stored at -20°C.…”

“…One antiplasmin unit was defined as the antiplasmin in 5 ^liters of 1:20 dilution of plasma which could inhibit by 0.5% the fibrinolytic activity of 5 //.liters of purified plasmin at a concentration of 2.5 Sgouris casein units/ml after 2% hours of incubation at 37°C (7). Fibrin degradation products in serum were estimated by the tanned red cell hemagglutination inhibition test using antifibrinogen antiserum 2 and human group O red cells (8).…”

The effect of Premarin on blood loss attending open heart surgery

“…EXCESSIVE postoperative bleeding following open intracardiac surgery has been attributed to disturbances of blood coagulation and fibrinclysis (Perkins et al, 1959;Cans and Krivit, 1962;Kendall and Lowenstein, 1963;Douglas et al, 1966;Woods et al, 1967).…”