Managing Fibrinolysis Without Aprotinin

Cardiopulmonary bypass increases perioperative bleeding and produces a consumptive coagulopathy, which is defined as the simultaneous production of thrombin and fibrinolysis. Thrombin formation and fibrinolysis primarily occur in the surgical wound and peak at the time heparin is reversed by protami...

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Bibliographic Details
Published inThe Annals of thoracic surgery Vol. 89; no. 1; pp. 324 - 331
Main Author Edmunds, L. Henry, MD
Format Journal Article
LanguageEnglish
Published New York, NY Elsevier Inc 2010
Elsevier
Subjects
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Antifibrinolytic Agents - therapeutic use
Aprotinin
Biological and medical sciences
Cardiac Surgical Procedures
Cardiology. Vascular system
Cardiothoracic Surgery
Contraindications
Fibrinolysis - drug effects
Hemostatics
Humans
Medical sciences
Pneumology
Postoperative Hemorrhage - drug therapy
Surgery
Treatment Outcome
16
Peptidases
Enzyme
Enzyme inhibitor
Hydrolases
Anesthesia
Aprotinin
Antifibrinolytic
Circulatory system
Cardiology
Fibrinolysis
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Summary:Cardiopulmonary bypass increases perioperative bleeding and produces a consumptive coagulopathy, which is defined as the simultaneous production of thrombin and fibrinolysis. Thrombin formation and fibrinolysis primarily occur in the surgical wound and peak at the time heparin is reversed by protamine. Neither aprotinin nor lysine analogs successfully control bleeding in many complex procedures, reoperations, aortic resections, or in implantations of mechanical circulatory devices. This analysis reviews the mechanisms involved and current treatment protocols, with the conclusion that changes in treatment protocols rather than use of a specific anti-fibrinolytic drug may provide better control of bleeding in these patients.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
ISSN:0003-4975
1552-6259
DOI:10.1016/j.athoracsur.2009.10.043