A retrospective survey of fibrinolysis as an indicator of poor outcome after cardiopulmonary bypass and a possible early sign of systemic inflammation syndrome.
A retrospective survey was undertaken of 142 adults who had undergone cardiac surgery with cardiopulmonary bypass. According to the manufacturer's instructions for thromboelastography, patients were identified as showing evidence of fibrinolysis if after coming off bypass the Ly30 index was > or =7.5%. In the 20 fibrinolytic patients, fibrinolysis was readily corrected by tranexamic acid but these patients needed more colloid and more vasopressor support than the non-fibrinolytic patients. There were three deaths, all in the fibrinolytic patients. It is possible that fibrinolysis is a marker for onset of systemic inflammation syndrome. It is recommended that, until the association between fibrinolysis and worse outcome is investigated further, patients showing fibrinolysis early after cardiopulmonary bypass should not be discharged too soon from intensive care.
Cvachovec
K
K
Department of Anaesthesiology and Critical Care Medicine and Second School of Medicine Charles University and Postgraduate School of Medicine Praha, Czech Republic.
Horácek
M
M
Vislocký
I
I
D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid