Fibrin-dependent fibrinolytic activity during extracorporeal circulation

Thromb Res. 1991 Feb 15;61(4):369-73. doi: 10.1016/0049-3848(91)90650-l.

Abstract

Cardiopulmonary By-Pass (CPB) Surgery may at times induce a haemostatic defect, at present not too well understood, causing severe bleeding from the operative site and chest tube drain. We present here some data on antigen increase in tissue Plasminogen Activator (tPA) and D 2 Dimer (D2D) detected during CPB and apparently not compensated by enhanced Plasminogen Activator Inhibitor type 1 (PAI 1) activity. tPA concentration (antigenic) ranged around 6.15 ng/ml (SD 5.6) before thoracotomy and 5.8 g/ml (SD 4.74) 5-10 minutes after a heparin 250 IU/Kg bolus injection. During CPB, tPA increased to 20.34 ng/ml (SD 9.17) before protamine infusion, and 16.93 ng/ml (SD 8.13) after heparin neutralization. As the D2D went up to 2000-4000 ng/ml (before/after protamine) and it was not correlated by fibrinogen consumption or FDP production, we find these observations suggestive of fibrin-dependent fibrinolytic activity, as an acquired haemostatic defect developed during CPB.

MeSH terms

  • Adult
  • Aged
  • Bleeding Time
  • Blood Coagulation Disorders / physiopathology*
  • Cardiopulmonary Bypass*
  • Extracorporeal Circulation*
  • Fibrin / physiology*
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinogen / analysis
  • Fibrinolysis / physiology*
  • Humans
  • Middle Aged
  • Plasminogen Inactivators / analysis
  • Tissue Plasminogen Activator / analysis

Substances

  • Fibrin Fibrinogen Degradation Products
  • Plasminogen Inactivators
  • fibrin fragment D
  • Fibrin
  • Fibrinogen
  • Tissue Plasminogen Activator