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Infant cardiopulmonary bypass: a procoagulant state
J J Jaggers1, M C Neal, P K Smith
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. jagge003@mc.duke.edu
The Annals of Thoracic Surgery
|September 4, 1999
Summary
Infants undergoing cardiopulmonary bypass (CPB) show altered coagulation and fibrinolytic systems. Post-CPB serum induces endothelial procoagulant activity, indicating a potential hypercoagulable state in infants after cardiac surgery.
Area of Science:
- Pediatric Cardiology
- Hematology
- Vascular Biology
Background:
- Cardiopulmonary bypass (CPB) in infants may lead to thrombotic and bleeding complications.
- Tissue factor and prothrombinase activity on endothelial cells are key in activating the extrinsic clotting cascade.
Purpose of the Study:
- To characterize the fibrinolytic and endothelial procoagulant state in infants undergoing congenital cardiac repairs.
- To compare these states in infants with and without CPB.
Main Methods:
- 14 infants (1-12 weeks) underwent cardiac repair (2 closed, 12 open).
- Serum samples collected pre- and post-CPB (1, 4, 24 hours).
- Measured tissue plasminogen activator, plasminogen activator inhibitor-1, IL-1beta, IL-6, tissue factor, and factor V. Assayed endothelial cell cultures for tissue factor and prothrombinase activity.
Main Results:
- CPB-treated infants showed transient increases in tissue plasminogen activator and plasminogen activator inhibitor-1.
- Endothelial tissue factor activity was induced post-CPB, with prothrombinase activity remaining elevated.
- Serum factor V levels decreased significantly after CPB but recovered by 24 hours.
Conclusions:
- Cardiopulmonary bypass disrupts coagulation and fibrinolytic systems in infants.
- Post-CPB serum promotes endothelial procoagulant activity.
- A hypercoagulable state may exist in infants during the post-CPB period.