title: Early activation of hemostasis during cardiopulmonary bypass: evidence for thrombin mediated hyperfibrinolysis.
abstract: In 14 consecutive patients undergoing cardiopulmonary bypass for coronary bypass surgery the time course of coagulation and fibrinolysis markers were measured, e. g. plasma levels of thrombin-antithrombin III (TAT) complexes, cross-linked fibrin degradation products (XIFDP) and plasmin-alpha 2-antiplasmin complexes (PAP). TAT levels exceeded the 90% baseline percentile already during CPB (after opening of aortic clamp) in 10 patients, whereas PAP and XIFDP exceeded their 90% percentile in only one patient at this time. Concerning fibrinolysis markers PAP and XIFDP the majority of patients showed elevations higher than their 90% baseline percentile only 1 h postoperation. Correlation analysis revealed significant dependencies between TAT levels during and at the end of CPB and PAP levels 1 h postoperation (R = 0.55 and R = 0.56 respectively). Furthermore, 1 h postoperation XIFDP levels were significantly correlated with both TAT and PAP. Peak XIFDP levels at the same time correlated with blood loss via thoracic drains (R = 0.56). Thus, we suggest that hyperfibrinolysis in patients undergoing CPB is at least partly due to hypercoagulation. Clinically, this may implicate that intensified anticoagulation could prevent hyperfibrinolysis and reduce postoperative blood loss.
authors.affiliation: Department of Medicine II, University of Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Teufelsbauer
authors.forename: S
authors.initials: S
authors.lastname: Proidl
authors.forename: M
authors.initials: M
authors.lastname: Havel
authors.forename: T
authors.initials: T
authors.lastname: Vukovich
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000503:physiopathology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005342:Fibrinolysis / Q000502:physiology*; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000502:physiology*
chemical_list: D013917:Thrombin