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EDITORIAL

Reducing Hemostatic Activation During Cardiopulmonary Bypass: A Combined Approach

Michael J. Eisses, MD^*, Kristy Seidel, MS, Gabriel S. Aldea, MD, and Wayne L. Chandler, MD

Departments of *Anesthesiology, Cardiothoracic Surgery, and Laboratory Medicine, University of Washington, Seattle, Washington; and Department of Research Administration, Children’s Hospital and Regional Medical Center, Seattle, Washington

Address correspondence and reprint requests to Michael J. Eisses, MD, 4800 Sand Point Way N.E., Department of Anesthesia, Mail Stop 4D-1, Children’s Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105. Address e-mail to michael.eisses{at}seattlechildrens.org

Abstract

Interventions such as heparin-coated circuits, -aminocaproic acid, and reduced shed blood reinfusion have shown mixed results when applied individually for limiting hemostatic activation during cardiopulmonary bypass (CPB). We compared coagulation and fibrinolytic activation during conventional CPB (control) (CTRL) using noncoated circuits, no antifibrinolytics, and open cardiotomy with a combined strategy (HAC) that used heparin-coated circuits, -aminocaproic acid, and closed cardiotomy. Blood samples were drawn before, during, and after CPB for primary coronary bypass grafting surgery from 9 CTRL patients and 10 HAC patients. Thrombin-antithrombin complex and fibrinopeptide A levels (markers of thrombin and fibrin generation) were reduced in the HAC versus CTRL group after 30 min of CPB (P < 0.05). Average tissue plasminogen activator (tPA) levels were significantly lower in the HAC group by 30 min on CPB (P < 0.05), resulting in preservation of plasminogen activator inhibitor (PAI)-1 during CPB (P < 0.05). D-Dimer, a measure of intravascular fibrin formation and removal, was reduced in the HAC group during and after CPB (P < 0.005). Overall, the combined strategy was associated with a reduction in CPB-induced increases in markers of thrombin generation, fibrin formation, tPA release, and fibrin degradation and better preservation of PAI-1.

IMPLICATIONS: A combined approach during cardiopulmonary bypass (CPB) that uses heparin-coated circuits, -aminocaproic acid, and limited reinfusion of shed pericardial blood is associated with reduced activation of the coagulation and fibrinolytic systems that typically occurs during conventional CPB.

This article has been cited by other articles:

				M. Pretorius, B. S. Donahue, C. Yu, J. P. Greelish, D. M. Roden, and N. J. Brown Plasminogen Activator Inhibitor-1 as a Predictor of Postoperative Atrial Fibrillation After Cardiopulmonary Bypass Circulation, September 11, 2007; 116(11_suppl): I-1 - I-7. [Abstract] [Full Text] [PDF]

				J. M. van den Goor, R. Nieuwland, P. M. Rutten, J. G. Tijssen, C. Hau, A. Sturk, L. Eijsman, and B. A. de Mol Retransfusion of pericardial blood does not trigger systemic coagulation during cardiopulmonary bypass Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1029 - 1036. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999