Thrombin During Cardiopulmonary Bypass

• Published in: The Annals of thoracic surgery Vol. 82; no. 6; pp. 2315 - 2322
• Main Authors: Edmunds, L. Henry, Colman, Robert W.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2006; Elsevier Science
• Subjects: Anticoagulants - therapeutic use; Biological and medical sciences; Blood Coagulation - drug effects; Blood Coagulation - physiology; Blood Platelets - physiology; Cardiopulmonary Bypass - methods; Fibrinolysis - drug effects; Fibrinolysis - physiology; Heparin - therapeutic use; Humans; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Thrombin - physiology; Thrombosis - physiopathology; 25; Cardiopulmonary bypass; Peptidases; Treatment; Serine endopeptidases; Enzyme; Respiratory disease; Surgery; Hydrolases; Thrombin; Thorax
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.06.072

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.