Thromb Haemost 1990; 63(02): 241-245
DOI: 10.1055/s-0038-1645202
Original Article
Schattauer GmbH Stuttgart

Enhanced Effective Fibrinolysis following the Neutralization of Heparin in Open Heart Surgery Increases the Risk of Post-Surgical Bleeding

Jørgen Gram
1   The Department of Internal Medicine, Kiinikum der Christian-Albrechts-Universität, Kiel, Federal Republic of Germany
2   The Section of Coagulation and Fibrinolysis, Department of Clinical Chemistry, Ribe County Hospital in Esbjerg, Esbjerg, Denmark
,
Thomas Janetzko
1   The Department of Internal Medicine, Kiinikum der Christian-Albrechts-Universität, Kiel, Federal Republic of Germany
,
Jørgen Jespersen
2   The Section of Coagulation and Fibrinolysis, Department of Clinical Chemistry, Ribe County Hospital in Esbjerg, Esbjerg, Denmark
,
Hans Dietrich Bruhn
1   The Department of Internal Medicine, Kiinikum der Christian-Albrechts-Universität, Kiel, Federal Republic of Germany
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Publikationsverlauf

Received 26. Juni 1989

Accepted after revision 23. November 1989

Publikationsdatum:
02. Juli 2018 (online)

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Summary

The tissue-type plasminogen activator related fibrinolytic system was studied in 24 patients undergoing cardiopulmonary bypass surgery. The degradation of fibrinogen and fibrin was followed during and after surgery by means of new sensitive and specific assays and the changes were related to the blood loss measured in the chest tube drain during the first 24 postoperative hours. Although tissue-type plasminogen activator was significantly released into the circulation during the period of extracor-poreal circulation (p <0.01), constantly low levels of fibrinogen degradation products indicated that a systemic generation of plasmin could be controlled by the naturally occurring inhibitors. Following extracorporeal circulation heparin was neutralized by protamine chloride, and in relation to the subsequent generation of fibrin, there was a short period with increased concentrations of fibrinogen degradation products (p <0.01) and a prolonged period of degradation of cross-linked fibrin, as detected by increased concentrations of D-Dimer until 24 h after surgery (p <0.01). Patients with a higher than the median blood loss (520 ml) in the chest tube drain had a significantly higher increase of D-Dimer than patients with a lower than the median blood loss (p <0.05).

We conclude that the incorporation of tissue-type plasminogen activator into fibrin and the in situ activation of plasminogen enhance local fibrinolysis, thereby increasing the risk of bleeding in patients undergoing open heart surgery