Current status of antifibrinolytics in cardiopulmonary bypass and elective deep hypothermic circulatory arrest.
Cardiopulmonary bypass (CPB) results in many physiologic derangements, including activation of the hemostatic and fibrinolytic pathways. Deep hypothermic circulatory arrest (DHCA) adds a further insult to the coagulation systems because it involves more extreme hypothermia and organ ischemia related to blood stasis. The abnormalities induced by CPB disrupt the checks and balances in the hemostatic and fibrinolytic systems, resulting in a pathologic state that leads to excessive bleeding and other perioperative complications. Prophylactic antifibrinolytic therapy can attenuate the response to this insult by restoring the delicate balance within these systems, potentially reducing the complication rate and improving patient outcomes.
Green
Jeffrey A
JA
Department of Anesthesiology, Virginia Commonwealth University, Medical College of Virginia Campus, 1200 East Broad Street, PO Box 980695, Richmond, VA 23209, USA. jagreen2@vcu.edu
Spiess
Bruce D
BD
D000818:Animals; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*
D000933:Antifibrinolytic Agents