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CARDIOVASCULAR ANESTHESIA

Increased Fibrinolysis and Platelet Activation in Elderly Patients Undergoing Coronary Bypass Surgery

Hilde Pleym, MD^*, Alexander Wahba, MD, PhD^¶, Vibeke Videm, MD, PhD^#, Arne Åsberg, MD, PhD, Stian Lydersen, PhD^||, Lise Bjella, MD, Ola Dale, MD, PhD^*, and Roar Stenseth, MD, PhD^¶

*Department of Cardiothoracic Anesthesia and Intensive Care, Department of Cardiothoracic Surgery, Department of Immunology and Transfusion Medicine, and Department of Medical Biochemistry, St. Olav University Hospital, and ||Unit for Applied Clinical Research, ¶Department of Circulation and Medical Imaging, and #Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway

Address correspondence and reprint requests to Hilde Pleym, MD, St. Elisabeth Department of Cardiothoracic Surgery, Hans Nissens gate 3, N-7018 Trondheim, Norway. Address e-mail to hilde.pleym{at}stolav.no.

Reexploration for hemorrhage after cardiac surgery is associated with increased morbidity and mortality. Elderly cardiac surgical patients have an increased risk of excessive bleeding and reexploration. In the present study we investigated the perioperative hemostatic function in elderly patients compared with younger patients undergoing coronary artery bypass grafting. Twenty-five elderly (75 yr and older) and 25 younger (younger than 60 yr) patients were included in the study. Blood samples for the analysis of platelet counts, international normalized ratio, activated partial thromboplastin time, fibrinogen, d-dimer, antithrombin, prothrombin fragment 1 + 2, thrombin-antithrombin complex, plasmin inhibitor, neutrophil-activating peptide 2, and platelet-monocyte complexes were drawn preoperatively, 30 min, and 3 h postoperatively and approximately 20 h postoperatively. Elderly patients had an increased activation of the hemostatic system. In particular, elderly patients showed a more pronounced increase in fibrinolysis and platelet activation postoperatively compared with younger patients.

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