SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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M Zivkovic1 , K Brkic2 , N Nikic3 , Z Romic1 , D Hasperger1 , D Vukelic 1 , I Husedzinovic3 , Z Sutlic2

1Departement of Laboratory Diagnostics, Dubrava University Hospital, Zagreb, Croatia, 2Departement of Cardiac Surgery, Dubrava University Hospital, Zagreb, Croatia, 3Departement of Anesthesiology and Intensive Care of Cardiac Surgery, Dubrava University Hospital, Zagreb, Croatia

Myocardial revascularization (bypass) is a cardiosurgical procedure that can be performed with or without the use of extracorporeal circulation (ECC). The blood flowing over surfaces without endothelial lining leads to activation of coagulation, fibrinolysis and inflammatory reaction.
The aim of this study was to investigate the differences in fibrinolytic activity by monitoring the dynamics of plasminogen and D-dimers during bypass procedure and 24 hours later, depending on the use of ECC.
We included 28 patients in our study, 14 of which were operated with the use of ECC (on-pump), and the other 14 without (off-pump). Both patient groups recieved the same anesthesia protocol and hemodynamic control, whereas antifibrinolytics were not used. The on-pump group recieved 3mg/kg of heparin, and the off-pump group 1 mg/kg of heparin.
Sampeling of whole blood was performed after administrating anesthesia, after heparin and protamine introduction, at the end of the surgery, and the morning after the surgery. Plasminogen and D-dimer concentrations were determined in plasma.
Plasminogen concentrations were significantly different between groups at the end of the surgery (p=0,027). In comparison with the beginning of the surgery, in the on-pump group plasminogen concentration decreased 24% (p=0,001), and in off-pump group 17% (p=0,001).
Statistically significant between-group difference in the concentration of D-dimers showed after protamine introduction (p=0,003) and at the end of the surgery (p=0,005).
In comparison with the baseline levels, D-dimer concentrations were significantly different after protamine introduction (p=0,001) in the on-pump group. The next morning, the values of the parameters were leveled in both groups. In the on-pump group, fibrinolysis was more pronounced and more dynamic, and was induced by activation of fibrinolysis because of the use of ECC. In the off-pump group, fibrinolysis was the normal physiological response to operative procedure per se.


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