Platelet function during cardiac surgery and cardiopulmonary bypass with low-dose aprotinin

Abstract Background: The blood saving efficacy of TXA in cardiac surgery has been proved in several studies, but TXA dosing regimens were varied in those studies. Therefore, we performed this study to investigate if there is a dose dependent in-vivo effect of TXA on fibrinolysis parameters by measurement of fibrinolysis markers in adults undergoing cardiac surgery with CPB, which has not been systematically elucidated.Methods: A double-blind, randomized, controlled prospective trial was conducted from February 11, 2017 to May 05, 2017. Thirty patients undergoing cardiac valve surgery were identified and randomly divided into a placebo group, low-dose group and high-dose group by 1: 1: 1. Fibrinolysis parameters were measured by plasma levels of D-Dimers, plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), plasmin-antiplasmin complex (PAP), tissue plasminogen activator (tPA) and thrombomodulin (TM). Those proteins were measured at five different sample times: preoperatively before the TXA injection (T1), 5 min after the TXA bolus (T2), 5 min after the initiation of CPB (T3), 5 min before the end of CPB (T4) and 5 min after the protamine administration (T5). A Thrombelastography (TEG) and standard coagulation test were also performed.Results: Compared with the control group, the level of the D-Dimers decreased in the low-dose and high-dose groups when the patients arrived at the ICU and on the first postoperative morning. Over time, the concentrations of PAI-1, TAFI, and TM, but not PAP and tPA, showed significant differences between the three groups (p <0.05). Compared with the placebo group, the plasma concentrations of PAI-1 and TAFI decreased significantly at the T3 and T4 (p <0.05); TAFI concentrations also decreased at the T5 in low-dose group (p <0.05). Compared with the low-dose group, the concentration of TM increased significantly at the T4 in high-dose group. No significant differences were observed in the levels of the coagulation proteins at any points between the groups.Conclusions: The vivo effect of low dose TXA is equivalent to high dose TXA on fibrinolysis parameters in adults undergoing valvular cardiac surgery with cardiopulmonary bypass, and we recommend a low dose TXA regimen for those patients.Clinical trial number and registry URL: ChiCTR-IPR-17010303; http://www.chictr.org.cn, Principal investigator: Zhen-feng ZHOU, Date of registration: January 1, 2017.

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Low dose aprotinin and low dose tranexamic acid in elective cardiac surgery with cardiopulmonary bypass

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-2009-1197 ◽

2009 ◽

Vol 42 (4) ◽

pp. 269-277 ◽

Cited By ~ 4

Author(s):

Thomas Waldow ◽

Diana Krutzsch ◽

Michael Wils ◽

Katrin Plötze ◽

Klaus Matschke

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Tranexamic Acid ◽

Low Dose ◽

Elective Cardiac Surgery

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Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

Perfusion ◽

10.1177/0267659119866289 ◽

2019 ◽

Vol 35 (2) ◽

pp. 138-144

Author(s):

Helena Argiriadou ◽

Polychronis Antonitsis ◽

Anna Gkiouliava ◽

Evangelia Papapostolou ◽

Apostolos Deliopoulos ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Correlation Coefficient ◽

Platelet Function ◽

Extracorporeal Circulation ◽

Point Of Care ◽

Postoperative Bleeding ◽

Minimal Invasive ◽

Elective Cardiac Surgery ◽

Impedance Aggregometry

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

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Factors Facilitating the Success of Fast Endotracheal Extubation after Cardiac Surgery

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.03.11560 ◽

2021 ◽

Vol 104 (3) ◽

pp. 388-395

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Low Dose ◽

Heart Surgery ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Factors Influencing ◽

Post Cardiopulmonary Bypass ◽

One Year ◽

Endotracheal Extubation

Objective: To study factors influencing fast endotracheal extubation after cardiac surgery. Materials and Methods: A one-year retrospective cohort study conducted via hospital medical informatics, included patients aged over 15 years old that underwent elective valvular heart surgery by means of cardiopulmonary bypass under general anesthesia. Results: Fifty-seven patients were enrolled in the present study including nine (15.8%) as fast endotracheal extubation in the operating theatre, 18 (31.6%) within eight hours postoperatively, and 30 (52.6%) non-fast endotracheal extubation eight hours after surgery. The preoperative and intraoperative factors were a younger age (p=0.018), high % left ventricular ejection function (LVEF) (p=0.023), and low creatinine level (p=0.026), as well as post cardiopulmonary bypass dexmedetomidine (p=0.01), reversal of muscle relaxant (p=0.004), and low dose dobutamine (p=0.003), respectively. However, multiple logistic regression analyses showed only two favorable factors, which were preoperative % LVEF of 60 or more (adjusted OR 11.266, 95% CI 1.700 to 74.664, p=0.012), and the intraoperative low dose dobutamine of 3 μg/kg/minute or less (adjusted OR 6.896, 95% CI 1.463 to 32.510, p=0.015). In addition, there were no significant complications. Conclusion: The factors influencing fast endotracheal extubation were preoperative% LVEF of 60 or more and intraoperative low dose dobutamine of 3 μg/kg/minute or less. Keywords: Cardiac surgery, Fast endotracheal extubation, Valvular heart disease

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Time-dependent changes in intraplatelet signaling pathways relevant to platelet function defect after cardiac surgery with cardiopulmonary bypass

European Journal of Anaesthesiology ◽

10.1097/00003643-201006121-00328 ◽

2010 ◽

Vol 27 ◽

pp. 103

Author(s):

M. Murase ◽

Y. Nakajima ◽

D. Sessler ◽

M. Shibasaki ◽

T. Mizobe

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Signaling Pathways ◽

Platelet Function ◽

Time Dependent ◽

Function Defect

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Low-Dose Versus High-Dose Tranexamic Acid Reduces the Risk of Nonischemic Seizures After Cardiac Surgery With Cardiopulmonary Bypass

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2017.04.026 ◽

2017 ◽

Vol 31 (5) ◽

pp. 1611-1617 ◽

Cited By ~ 12

Author(s):

Pierre Couture ◽

Jean-Sébastien Lebon ◽

Éric Laliberté ◽

Georges Desjardins ◽

Marie-Ève Chamberland ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Tranexamic Acid ◽

Low Dose ◽

High Dose

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Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Transfusion Medicine ◽

10.1111/tme.12678 ◽

2020 ◽

Vol 30 (5) ◽

pp. 369-376 ◽

Cited By ~ 1

Author(s):

Gunilla Kjellberg ◽

Manne Holm ◽

Gabriella Lindvall ◽

Gunilla Gryfelt ◽

Jan Linden ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Platelet Function ◽

Platelet Transfusion

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Comparison of the in-vivo effect of two tranexamic acid doses on fibrinolysis parameters in adults undergoing valvular cardiac surgery with cardiopulmonary bypass - a pilot investigation

BMC Anesthesiology ◽

10.1186/s12871-021-01234-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhen-feng Zhou ◽

Wen Zhai ◽

Li-na Yu ◽

Kai Sun ◽

Li-hong Sun ◽

...

Keyword(s):

Cardiac Surgery ◽

Placebo Group ◽

Cardiopulmonary Bypass ◽

Plasminogen Activator ◽

Dose Group ◽

Low Dose ◽

High Dose Group ◽

High Dose ◽

Pai 1

Abstract Background The blood saving efficacy of TXA in cardiac surgery has been proved in several studies, but TXA dosing regimens were varied in those studies. Therefore, we performed this study to investigate if there is a dose dependent in-vivo effect of TXA on fibrinolysis parameters by measurement of fibrinolysis markers in adults undergoing cardiac surgery with CPB. Methods A double-blind, randomized, controlled prospective trial was conducted from February 11, 2017 to May 05, 2017. Thirty patients undergoing cardiac valve surgery were identified and randomly divided into a placebo group, low-dose group and high-dose group by 1: 1: 1. Fibrinolysis parameters were measured by plasma levels of D-Dimers, plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), plasmin-antiplasmin complex (PAP), tissue plasminogen activator (tPA) and thrombomodulin (TM). Those proteins were measured at five different sample times: preoperatively before the TXA injection (T1), 5 min after the TXA bolus (T2), 5 min after the initiation of CPB (T3), 5 min before the end of CPB (T4) and 5 min after the protamine administration (T5). A Thrombelastography (TEG) and standard coagulation test were also performed. Results Compared with the control group, the level of the D-Dimers decreased in the low-dose and high-dose groups when the patients arrived at the ICU and on the first postoperative morning. Over time, the concentrations of PAI-1, TAFI, and TM, but not PAP and tPA, showed significant differences between the three groups (P < 0.05). Compared with the placebo group, the plasma concentrations of PAI-1 and TAFI decreased significantly at the T3 and T4 (P < 0.05); TAFI concentrations also decreased at the T5 in low-dose group (P < 0.05). Compared with the low-dose group, the concentration of TM increased significantly at the T4 in high-dose group. Conclusions The in-vivo effect of low dose TXA is equivalent to high dose TXA on fibrinolysis parameters in adults with a low bleeding risk undergoing valvular cardiac surgery with cardiopulmonary bypass, and a low dose TXA regimen might be equivalent to high dose TXA for those patients. Trial registration ChiCTR-IPR-17010303, Principal investigator: Zhen-feng ZHOU, Date of registration: January 1, 2017.

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