Thrombin during cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) ignites a massive defense reaction that stimulates all blood cells and five plasma protein systems to produce a myriad of vasoactive and cytotoxic substances, cell-signaling molecules, and upregulated cellular receptors. Thrombin is the key enzyme in the thrombotic portion of the defense reaction and is only partially suppressed by heparin. During CPB, thrombin is produced by both extrinsic and intrinsic coagulation pathways and activated platelets. The routine use of a cell saver and the eventual introduction of direct thrombin inhibitors now offer the possibility of completely suppressing thrombin production and fibrinolysis during cardiac surgery with CPB.
Edmunds
L Henry
LH
Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. hank.edmunds@uphs.upenn.edu
Colman
Robert W
RW
D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D001792:Blood Platelets / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005342:Fibrinolysis / Q000187:drug effects / Q000502:physiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D013917:Thrombin / Q000502:physiology*; D013927:Thrombosis / Q000503:physiopathology
D000925:Anticoagulants; D006493:Heparin; D013917:Thrombin