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Current status of antifibrinolytics in cardiopulmonary bypass and elective deep hypothermic circulatory arrest

Jeffrey A Green1, Bruce D Spiess

  • 1Department of Anesthesiology, Virginia Commonwealth University, Medical College of Virginia Campus, 1200 East Broad Street, PO Box 980695, Richmond, VA 23209, USA. jagreen2@vcu.edu

Anesthesiology Clinics of North America
|October 18, 2003
PubMed

Insights

Cardiopulmonary bypass and deep hypothermic circulatory arrest disrupt blood clotting. Prophylactic antifibrinolytic therapy may restore balance, reduce bleeding, and improve patient outcomes during cardiac surgery.

Area of Science:

  • Cardiovascular Surgery
  • Hemostasis and Thrombosis
  • Anesthesiology

Background:

  • Cardiopulmonary bypass (CPB) triggers significant physiological disruptions, notably activating hemostatic and fibrinolytic pathways.
  • Deep hypothermic circulatory arrest (DHCA) exacerbates these issues due to extreme hypothermia and ischemia, further compromising coagulation.
  • These CPB-induced abnormalities disrupt the natural balance of hemostasis and fibrinolysis, leading to pathological bleeding and perioperative complications.

Purpose of the Study:

  • To investigate the impact of CPB and DHCA on hemostatic and fibrinolytic systems.
  • To evaluate the potential of prophylactic antifibrinolytic therapy in mitigating CPB-induced coagulopathy.
  • To assess the role of antifibrinolytics in improving patient outcomes and reducing complications in cardiac surgery.

Main Methods:

  • Review of physiological derangements associated with CPB and DHCA.
  • Analysis of the mechanisms underlying CPB-induced disruption of hemostatic and fibrinolytic pathways.
  • Evaluation of the therapeutic potential of antifibrinolytic agents in managing surgical bleeding.

Main Results:

  • CPB and DHCA significantly activate both hemostatic and fibrinolytic pathways.
  • Disruption of coagulation balance leads to excessive perioperative bleeding.
  • Antifibrinolytic therapy shows promise in restoring hemostatic balance.

Conclusions:

  • Prophylactic antifibrinolytic therapy can attenuate the adverse effects of CPB and DHCA on coagulation.
  • Restoring the balance in hemostatic and fibrinolytic systems may reduce complications.
  • Antifibrinolytic use could lead to improved patient outcomes in complex cardiac surgeries.

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