| Title | Relationship of fibrinolysis and platelet function to bleeding after cardiopulmonary bypass. | | Author(s) | Ray MJ, Marsh NA, Hawson GA | | Institution | Department of Haematology, Prince Charles Hospital, Brisbane, Queensland, Australia. | | Source | Blood Coagul Fibrinolysis 1994 Oct; 5(5):679-85. | | MeSH | Adolescent
Adult
Aged
Aged, 80 and over
Antiplasmin
Blood Platelets
Cardiopulmonary Bypass
Female
Fibrin
Fibrin Fibrinogen Degradation Products
Fibrinogen
Fibrinolysis
Hemodilution
Hemorrhage
Humans
Male
Middle Aged
Plasminogen
Plasminogen Activator Inhibitor 1
Platelet Aggregation
Research Support, Non-U.S. Gov't
Tissue Plasminogen Activator
| | Abstract | In order to study the effects of cardiopulmonary bypass (CPB) on fibrinolysis and platelet function and the possible relationship of these effects on post-operative blood loss, 127 patients undergoing CPB were examined. There was a significant reduction in the median levels of fibrinogen, plasminogen, alpha 2-antiplasmin, fibrinolytic potential and platelet aggregation during CPB (P < or = 0.001). Median levels of soluble fibrin, fibrinogen degradation products, D-dimer and PAI-1 were increased, while the level of t-PA activity remained constant. Post-CPB levels of fibrinogen and plasminogen correlated negatively with blood loss (P = 0.003 and P < 0.001, respectively) and interestingly, lower levels of alpha 2-antiplasmin and higher levels of t-PA activity before CPB were associated with greater blood loss after CPB (P < 0.001 and P = 0.004, respectively). Better pre-CPB platelet function correlated with lower levels of D-dimer before and after CPB. As expected, haemodilution had a significant effect on fibrinolytic and coagulation parameters post-CPB; the greater the haemodilution, the more the concentration of fibrinogen, plasminogen and alpha 2-antiplasmin fell post-CPB and the greater the blood loss. The increase in PAI-1 levels intra-CPB appeared to result in mean t-PA activity remaining unchanged 1 h post-CPB. Post-CPB increases in soluble fibrin were paralleled by increases in fibrinogen degradation products and D-dimer, suggesting that intra-operative contact activation is related to activation of the fibrinolytic system. The present findings indicate the greater the fibrinolytic activation, the greater the post-CPB blood loss. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 7865673 |
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