engleski

The effect of extracorporeal circulation on plasminogen and D-dimers dynamics during myocardial revascularization

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 the study was to investigate the difference 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 patients groups received the same anesthesia protocol and hemodynamic control, whereas antifibrinolitics were not used. The on-pump group received 3 mg/kg of heparin, and the off-pump 1 kg/kg of heparin. Sampling of whole blood was performed after administrating anesthesia, after heparine and protamine introduction, at the end of surgery and next morning. Plasminogen and D-dimer concetrations were determined in plasma. //Plasminogen concetration were significantly different between groups at the end of surgery (p=0.027). In comparison with the beginning of the surgery, in the on-pump group plasminogen conetration decreased 24% (p=0.001) and 17% in the off-pump group (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 surgery (p=0.005). In comparison with the baseline levels, D-dimer concentration 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. Fibrinolysis was more pronounced and more dynamic in on-pump group due to systemic inflammatory response induced by the use of ECC. In off-pump group, fibrinolysis was a normal physiologic response to surgery procedure.

fibrinolysis; plasminogen; D-dimer; PAI-1; cardiac surgery

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