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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 828-833, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
N Tabuchi, J de Haan, PW Boonstra and W van Oeveren
The clotting and fibrinolytic systems are activated by tissue factor and by
tissue-type plasminogen activator in the pericardial cavity, where the
thrombogenicity is greater than that of the surface of modern
extracorporeal circuits. This local activation may have consequences for
the systemic activation processes during cardiopulmonary bypass. To test
this hypothesis, we investigated blood activation by interrupting the blood
suction from the pericardial cavity during cardiopulmonary bypass in
clinical coronary artery bypass operations. In blood collected in the
pericardial cavity, thrombin-antithrombin III complex (p < 0.01),
tissue-type plasminogen activator antigen (p < 0.05), fibrinogen
degradation products (p < 0.01), and fibrin degradation products (p <
0.01) were significantly higher than in the systemic blood. Plasma heparin
was significantly consumed in the pericardial cavity (p < 0.01). Once
the pericardial blood was returned to the systemic circulation after
resumed suction during cardiopulmonary bypass, thrombin-antithrombin III
complex (p < 0.05), fibrinogen degradation products (p < 0.05), and
fibrin degradation product (p < 0.05) concentrations increased
significantly in the systemic blood. The effects of pericardial tissue on
activation of clotting and fibrinolysis were also studied in vitro. When
human plasma was incubated for 5 minutes with rabbit pericardium at reduced
heparin concentrations, we found significant generation of thrombin (p <
0.05) and plasmin (p < 0.05). If the thrombin inhibitor hirudin was
added, plasmin generation was also inhibited (p < 0.05). The results of
the clinical and experimental study are in agreement with our hypothesis
that tissue factor and tissue-type plasminogen activator accelerate the
activation of clotting and sequentially of fibrinolysis under conditions of
low heparin concentrations in the pericardial cavity and that this local
activation contributes highly to the systemic activation, affecting
hemostasis during cardiopulmonary bypass. Topical use of heparin in the
pericardial cavity therefore seems indicated to reduce blood activation
during cardiopulmonary bypass.
ARTICLES
Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass
Thorax Centre, University Hospital Groningen, The Netherlands.
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C. Baufreton, P. G. M. Jansen, P. Le Besnerais, H. Velthuis, C. M. Thijs, C. R. H. Wildevuur, and D. Y. Loisance Heparin Coating With Aprotinin Reduces Blood Activation During Coronary Artery Operations Ann. Thorac. Surg., January 1, 1997; 63(1): 50 - 56. [Abstract] [Full Text]
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Y. J. Gu, J. de Haan, U. P. M. Brenken, W. J. de Boer, Jm. Prop, W. van Oeveren, and G. L. T. Group CLOTTING AND FIBRINOLYTIC DISTURBANCE DURING LUNG TRANSPLANTATION: EFFECT OF LOW-DOSE APROTININ J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 599 - 606. [Abstract] [Full Text]
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Y. J. Gu, R. J. Huyzen, and W. van Oeveren INTRINSIC PATHWAY-DEPENDENT ACTIVATED CLOTTING TIME IS NOT RELIABLE FOR MONITORING ANTICOAGULATION DURING CARDIOPULMONARY BYPASS IN NEONATES J. Thorac. Cardiovasc. Surg., March 1, 1996; 111(3): 677 - 678. [Full Text]
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S. Cicek and D. A. Theodoro Topical Aprotinin in Cardiac Operations: A Note of Caution Ann. Thorac. Surg., March 1, 1996; 61(3): 1039 - 1040. [Full Text]
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R. C. Gorman, N. P. Ziats, A. K. Rao, N. Gikakis, L. Sun, M. M. H. Khan, N. Stenach, S. Sapatnekar, V. Chouhan, J. H. Gorman III, et al. SURFACE-BOUND HEPARIN FAILS TO REDUCE THROMBIN FORMATION DURING CLINICAL CARDIOPULMONARY BYPASS J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 1 - 12. [Abstract] [Full Text]
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J. de Haan, P. W. Boonstra, N. Tabuchi, W. van Oeveren, and T. Ebels RETRANSFUSION OF THORACIC WOUND BLOOD DURING HEART SURGERY OBSCURES BIOCOMPATIBILITY OF THE EXTRACORPOREAL CIRCUIT J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 272 - 275. [Full Text]
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S. Cicek, H. Tatar, U. Demirklc, and E. Kuralay Topical use of aprotinin in cardiac surgery J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 568 - 569. [Full Text]
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J. de Haan, P. W. Boonstra, S. H. J. Monnink, T. Ebels, and W. van Oeveren Retransfusion of Suctioned Blood During Cardiopulmonary Bypass Impairs Hemostasis Ann. Thorac. Surg., April 1, 1995; 59(4): 901 - 907. [Abstract] [Full Text]
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N. Tabuchi, J. de Haan, and W. van Oeveren Topical effect of aprotinin on the surgical wound in cardiac surgery J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 399 - 400. [Full Text]
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L. H. Edmunds Jr. Invited letter concerning: Topical aprotinin J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 400 - 401. [Full Text]
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