Fibrin formation is more impaired than thrombin generation and platelets immediately following cardiac surgery

Department of Anaesthesiology and Intensive Care, Salzburger Landeskliniken SALK, Salzburg, Austria.
Thrombosis Research (Impact Factor: 2.45). 03/2011; 128(3):277-82. DOI: 10.1016/j.thromres.2011.02.022
Source: PubMed


Cardiac surgery performed on cardio-pulmonary bypass (CPB) may be complicated by coagulopathy and bleeding. This prospective observational study investigated the CPB-induced changes in thrombin generation, fibrin formation, and in the platelet component of the whole blood clot elasticity. The effects of haemostatic therapy with fresh frozen plasma (FFP) and platelet concentrate on these parameters were also evaluated.
In 90 cardiac surgery patients, thrombin generation was measured using the calibrated automated thrombogram, fibrin formation was assessed as the maximum clot elasticity of the fibrin-based clot in the thromboelastometry FIBTEM test (MCE(FIBTEM)), and the platelet component was defined as the difference in maximum elasticity between the whole blood clot obtained through extrinsic activation and the fibrin-based clot (MCE(EXTEM)-MCE(FIBTEM)). Blood samples were collected before surgery, immediately after CPB, and after administration of FFP or FFP and platelet concentrate.
Following CPB, the endogenous thrombin potential decreased to 93%, from median 1485 (interquartile range 1207, 1777) to 1382 (1190, 1533) nM*min (P>0.05), MCE(FIBTEM) decreased to 62%, from 21 (19, 29) to 14 (12, 19) (P<0.001), and the platelet component to 73%, from 139 (119, 174) to 101 (87, 121) (P<0.001). Administration of 11 (10, 13) ml per kg of bodyweight (ml/kgbw) FFP (40 patients), or of 13 (10, 18) ml/kgbw FFP and 7 (5, 9) ml/kgbw platelet concentrate (18 patients) brought no statistically significant changes in these parameters.
Fibrin formation is more impaired than thrombin generation and the platelet component of the whole blood clot immediately after cardiopulmonary bypass.

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    • "Schols et al.[6] showed a decrease in thrombin generation associated with a decrease in fibrin formation (assessed with thromboelastography). In addition, Solomon et al[7] have shown that fibrin formation is more altered than thrombin generation following CPB. Furthermore, Coakley et al.[8] have shown a correlation between pre- and post-operative Endogenous Thrombin Potentials (ETP), and more importantly an association with bleeding complications, suggesting that this assay is informative in this context [5]. "
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