Monitoring of fibrinolysis parameters during myocardial revascularization according to type of procedure
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Marcela Živković
, Kristina Brkić , Nada Nikić , Dragica Hašperger , Jasna Juriček , Ino Husedžinović and Željko Sutlić
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 24h 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.
References
1 Shore-Lesserson L. Point-of-care coagulation monitoring for cardiovascular patients: past and present. J Cardiothorac Vasc Anesth 2002; 16: 99–106. 10.1053/jcan.2002.29692Search in Google Scholar
2 Koster A, Fischer T, Praus M, Haberzettl H, Kuebler WM, Hetzer R, et al. Hemostatic activation and inflammatory response during cardiopulmonary bypass: impact of heparin management Anesthesiology 2002; 97: 837–41. 10.1097/00000542-200210000-00014Search in Google Scholar
3 Kojima T, Gando S, Morimoto Y, Mashio H, Goda Y, Kawahigashi H, et al. Systematic elucidation of effects of tranexamic acid on fibrinolysis and bleeding during and after cardiopulmonary bypass surgery. Thromb Res 2001; 104: 301–7. 10.1016/S0049-3848(01)00379-6Search in Google Scholar
4 Despotis GJ, Avidan MS, Hogue CW Jr. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thorac Surg 2001; 72: S1821–31. 10.1016/S0003-4975(01)03211-8Search in Google Scholar
5 Stein CM, Brown N, Vaughan DE, Lang CC, Wood AJ. Regulation of local tissue-type plasminogen activator release by endothelium-dependent and endothelium-independent agonists in human vasculature. J Am Coll Cardiol 1998; 32: 117–22. 10.1016/S0735-1097(98)00210-1Search in Google Scholar
6 Sutlić Ž, Unić D, Rudež I, Biočina B, Barić D, Kontić M. Implantation of aortic stentless bioprosthesis: case series. Croat Med J 2002; 43: 409–11. Search in Google Scholar
7 Biočina B, Sutlić Ž, Rudež I, Barić D, Unić D, Štambuk B. Multiple arterial off-pump coronary artery bypass grafting: a 5-year experience with clinical results. Heart Surg Forum 2003; 6: 132–4. Search in Google Scholar
8 McColl AJ, Keeble T, Hadjinikolaou L, Cohen A, Aitkenhead H, Glenville B, et al. Plasma antioxidants: evidence for a protective role against reactive oxygen species following cardiac surgery. Ann Clin Biochem 1998; 35: 616–23. 10.1177/000456329803500504Search in Google Scholar
9 Fears R, Esmail AF, Greenwood HC. Effect of heparin on the fibrinolytic response to plasminogen activators. Semin Thromb Hemost 1991; 17: 389–93. 10.1055/s-2007-1002641Search in Google Scholar
10 Bruce D, Spiess MD. Heparin: beyond an anticoagulant. In: Society of Cardiovascular Anesthesiologists. The relationship between coagulation, inflammation and endothelium – a pyramid towards outcome. Philadelphia: Wolters Kluwer Company, 2000:169–89. Search in Google Scholar
11 Casati V, Gerli C, Franco A, Della Valle P, Benussi S, Alfieri O, Torri G, et al. Activation of coagulation and fibrinolysis during coronary surgery: on-pump versus off-pump techniques. Anesthesiology 2001; 95: 1103–9. 10.1097/00000542-200111000-00013Search in Google Scholar
12 Hunt BJ, Parratt RN, Segal HC, Sheikh S, Kallis P, Yacoub M. Activation of coagulation and fibrinolysis during cardiothoracic operations. Ann Thorac Surg 1998; 65: 712–8. 10.1016/S0003-4975(97)01345-3Search in Google Scholar
13 Casati V, Della Valle P, Benussi S, Franco A, Gerli C, Baili P, et al. Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: comparison between on-pump and off-pump techniques. J Thorac Cardiovasc Surg 2004; 128: 83–91. 10.1016/j.jtcvs.2003.10.034Search in Google Scholar PubMed
14 Kongsgaard UE, Smith-Erichsen N, Geiran O, Bjornskau L. Changes in the coagulation and fibrinolytic systems during and after cardiopulmonary bypass surgery. Thorac Cardiovasc Surg 1989; 37: 158–62. 10.1055/s-2007-1020309Search in Google Scholar
15 Khuri SF, Valeri CR, Loscalzo J, Weinstein MJ, Birjiniuk V, Healey NA. Heparin causes platelet dysfunction and induces fibrinolysis before cardiopulmonary bypass. Ann Thorac Surg 1995; 60: 1008–14. 10.1016/0003-4975(95)00668-BSearch in Google Scholar
16 Comunale ME, Carr JM, Moorman RM, Robertson LK. Significance of D-dimer concentrations during and after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1996; 10: 477–81. 10.1016/S1053-0770(05)80008-4Search in Google Scholar
17 Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985; 29: 236–61. 10.2165/00003495-198529030-00003Search in Google Scholar
18 Rylatt DB, Blake AS, Cottis LE, Massingham DA, Fletcher WA, Masci PP, et al. An immunoassay for human D dimer using monoclonal antibodies. Thromb Res 1983; 31: 767–78. 10.1016/0049-3848(83)90108-1Search in Google Scholar
19 Elms MJ, Bunce IH, Bundesen PG, Rylatt DB, Webber AJ, Masci PP, et al. Measurement of crosslinked fibrin degradation products – an immunoassay using monoclonal antibodies. Thromb Hemost 1983; 50: 591–4. 10.1055/s-0038-1665263Search in Google Scholar
20 Whitaker AN, Elms MJ, Masci PP, Bundensen PG, Rylatt DB, Webber AJ, et al. Measurement of crosslinked fibrin derivatives in plasma: an immunoassay using monoclonal antibodies. J Clin Pathol 1984; 37: 882–7. 10.1136/jcp.37.8.882Search in Google Scholar
21 Marder VJ, Budzynski AZ, Barlow GH. Comparison of the physicochemical properties of fragment D derivatives of fibrinogen and fragment D–D of cross-linked fibrin. Biochim Biophys Acta 1976; 427: 1–14. 10.1016/0005-2795(76)90279-8Search in Google Scholar
22 Gaffney PJ, Joe F. The lysis of crosslinked human fibrin by plasmin yields initially a single molecular complex, D-dimer-E. Thromb Res 1979; 15: 673–87. 10.1016/0049-3848(79)90177-4Search in Google Scholar
23 Dempfle C-E. Use of D-dimer assays in the diagnosis of venous thrombosis. Semin Thromb Hemost 2000; 26: 631–41. 10.1055/s-2000-13221Search in Google Scholar PubMed
24 Stowe Rinder C. Platelets and their interactions. In: Society of Cardiovascular Anesthesiologists. The relationship between coagulation, inflammation and endothelium – a pyramid towards outcome. Philadelphia: Wolters Kluwer Company, 2000:107–28. Search in Google Scholar
25 Wagner C. Plasminogen activators (PA), plasminogen activator inhibitor (PAI). In: Thomas L, editor. Clinical laboratory diagnostics. Frankfurt/Main: TH-Books Verlagsgesellschaft mbH, 1998:638–40. Search in Google Scholar
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