Taking into account the complexity of enhanced bleeding after cardiac surgery, it might be difficult to isolate one factor as the denominator of bleeding. Our investigation indicates that low plasma levels of PAI-1 preoperatively and of t-PA/PAI- 1 complex postoperatively, in parallel with increased plasma concentration of D-dimer can be useful predictors of fibrinolysis, and thus, of increased postoperative blood loss. Therefore, by including screening of fibrinolytic markers pre – and postoperatively, we might be able to identify patients with low fibrinolytic inhibitory potential who might benefit from antifibrinolytic therapy prior to cardiac surgery.
ACT: Activated coagulation time; BMI: Body mass index; CABG: Coronary artery bypass grafting; CPB: Cardiopulmonary bypass; CTD: Chest tube drainage; EF: Ejection fraction; EuroSCORE: European System for Cardiac Operative Risk Evaluation; Hb: Blood hemoglobin concentration; ICU: Intensive care unit; INR: International normalized ratio; LMWH: Low-molecular-weight heparin; PAI-1: Plasminogen activator inhibitor type-1; PLT: Platelet count; PT: Prothrombin time; t-PA: Tissue plasminogen activator; t-PA/PAI-1: Tissue plasminogen activator/plasminogen activator inhibitor type-1 complex; SD: Standard deviation; T0: Preoperatively; T1: On admission to the intensive care unite; T6: Six hours after surgery; T24: Twenty-four hours after operation; u-PA: Urinary type plasminogen activator.
AO and ES conceived the study. ES was responsible for anesthesia and applied the same anesthetic procedure in all the patients. AO participated in the design and the administration of the study, informed the patients and obtained their written consent. IV, AK and AO collected the clinical and laboratory data for analysis. IJ carried out the coagulation and fibrinolysis immunoassays and interpreted the results. AO and ES performed the statistical analysis and interpreted the data. AO, IV, ES and LJB drafted the manuscript. All authors read and approved the final manuscript.
The study was supported by grant 2009/0147/1DP/22.214.171.124.2/09/IPIA/VIAA/009 from the European Social Fund. We thank American citizen, Mrs. Alexandra Saab Bjertnaes, MBA, for linguistic corrections.
BMC Anesthesiol. 2012;12(27) © 2012 BioMed Central, Ltd.