Spontaneous haemorrhage on apixaban masquerading as obstructive cholangitis after heart surgery

SummaryThe 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

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The Hemostatic Mechanism after Open-Heart Surgery

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646707 ◽

1978 ◽

Vol 39 (02) ◽

pp. 474-487 ◽

Cited By ~ 2

Author(s):

E R Cole ◽

F Bachmann ◽

C A Curry ◽

D Roby

Keyword(s):

Extracorporeal Circulation ◽

Heart Surgery ◽

Polyacrylamide Gel Electrophoresis ◽

Open Heart Surgery ◽

Coagulation System ◽

Open Heart ◽

Time Activity ◽

Post Surgery ◽

Plasma Fractions ◽

The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

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Blood Coagulation Studies and Extracorporeal Circulation in Man

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655073 ◽

1967 ◽

Vol 18 (03/04) ◽

pp. 634-646 ◽

Cited By ~ 6

Author(s):

N Thurnherr

Keyword(s):

Blood Coagulation ◽

Extracorporeal Circulation ◽

Blood Clotting ◽

Heart Surgery ◽

Open Heart Surgery ◽

Fibrinolytic System ◽

Open Heart ◽

Clotting Factors ◽

Blood Clotting Factors

SummaryBlood clotting investigations have been executed in 25 patients who have undergone open heart surgery with extracorporeal circulation. A description of alterations in the activity of blood clotting factors, the fibrinolytic system, prothrombin consumption and platelets during several phases of the operation is given.

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