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LETTER TO THE EDITOR

Coagulopathy After Cardiac Surgery

Intensive Care Unit; Hospital Universitario de Canarias; Tenerife, España; c/Ofra s/n, La Cuesta; La Laguna, Spain; jjjimenez_rivera{at}yahoo.es

To the Editor:

We agree with Duggan et al. (1) that hyperfibrinolysis plays an important role in postoperative bleeding after cardiac surgery, and plasminogen activator inhibitor type 1 (PAI-1) polymorphism has been involved in this process (2). However, although the title of the article is "‘Coagulopathy' after cardiac surgery ..." no data related to coagulation or fibrinolysis are included. The authors also sought to assess the relationship between PAI-1 mRNA and clinical outcomes, particularly related to postoperative bleeding and transfusion of coagulation products, but no algorithm for transfusion was established. Finally, the authors failed to report how many patients, who needed coagulation products, received antifibrinolytics previously, and how blood loss according to PAI-1 polymorphism was influenced by them.

A "gold standard methodology" for quantifying PAI-1 is difficult to establish. Analysis of PAI-1 mRNA is a promising strategy to quantify PAI-1 polymorphism involvement in postoperative bleeding. Some reports have shown lack of sensitivity between PAI-1 antigen and PAI-1 activity, but others have demonstrated a good correlation (3). For this reason, we believe that PAI-I plasma levels could improve this information. In any case, we congratulate authors on this new approach to management of postoperative bleeding.

REFERENCES

1. Duggan E, O'Dwyer MJ, Caraher E, Diviney D, McGovern E, Kelleher D, McManus R, Ryan T. Coagulopathy after cardiac surgery may be influenced by a functional plasminogen activator inhibitor polymorphism. Anesth Analg 2007; 104:1343–7[Abstract/Free Full Text]
2. Jimenez Rivera JJ, Iribarren JL, Raya JM, Nassar I, Lorente L, Perez R, Brouard M, Lorenzo JM, Garrido P, Barrios Y, Diaz M, Alarco B, Martinez R, Mora ML. Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study. J Cardiothorac Surg 2007;2:17[Medline]
3. Burzotta F, Iacoviello L, Di Castelnuovo A, Zamparelli R, D'Orazio A, Amore C, Schiavello R, Donati MB, Maseri A, Posthay GF, Andreotti F. 4G/5G PAI-1 promoter polymorphism and acute-phase levels of PAI-1 following coronary bypass surgery: a prospective study. J Thromb Thrombolysis 2003;16:149–54[Web of Science][Medline]

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