Relationship of fibrinolysis and platelet function to bleeding after cardiopulmonary bypass

• Published in: Blood coagulation & fibrinolysis Vol. 5; no. 5; p. 679
• Main Authors: Ray, M J, Marsh, N A, Hawson, G A
• Format: Journal Article
• Language: English
• Published: England 01.10.1994
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; alpha-2-Antiplasmin - metabolism; Blood Platelets - physiology; Cardiopulmonary Bypass - adverse effects; Female; Fibrin - metabolism; Fibrin Fibrinogen Degradation Products - metabolism; Fibrinogen - metabolism; Fibrinolysis; Hemodilution; Hemorrhage - blood; Hemorrhage - etiology; Humans; Male; Middle Aged; Plasminogen - metabolism; Plasminogen Activator Inhibitor 1 - metabolism; Platelet Aggregation; Tissue Plasminogen Activator - metabolism
• ISSN: 0957-5235
• DOI: 10.1097/00001721-199410000-00002

In order to study the effects of cardiopulmonary bypass (CPB) on fibrinolysis and platelet function and the possible relationship of these effects on post-operative blood loss, 127 patients undergoing CPB were examined. There was a significant reduction in the median levels of fibrinogen, plasminogen, alpha 2-antiplasmin, fibrinolytic potential and platelet aggregation during CPB (P < or = 0.001). Median levels of soluble fibrin, fibrinogen degradation products, D-dimer and PAI-1 were increased, while the level of t-PA activity remained constant. Post-CPB levels of fibrinogen and plasminogen correlated negatively with blood loss (P = 0.003 and P < 0.001, respectively) and interestingly, lower levels of alpha 2-antiplasmin and higher levels of t-PA activity before CPB were associated with greater blood loss after CPB (P < 0.001 and P = 0.004, respectively). Better pre-CPB platelet function correlated with lower levels of D-dimer before and after CPB. As expected, haemodilution had a significant effect on fibrinolytic and coagulation parameters post-CPB; the greater the haemodilution, the more the concentration of fibrinogen, plasminogen and alpha 2-antiplasmin fell post-CPB and the greater the blood loss. The increase in PAI-1 levels intra-CPB appeared to result in mean t-PA activity remaining unchanged 1 h post-CPB. Post-CPB increases in soluble fibrin were paralleled by increases in fibrinogen degradation products and D-dimer, suggesting that intra-operative contact activation is related to activation of the fibrinolytic system. The present findings indicate the greater the fibrinolytic activation, the greater the post-CPB blood loss.