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Related Experiment Videos

Thrombin during cardiopulmonary bypass.

L Henry Edmunds1, Robert W Colman

  • 1Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. hank.edmunds@uphs.upenn.edu

The Annals of Thoracic Surgery
|November 28, 2006
PubMed
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Cardiopulmonary bypass (CPB) triggers a significant inflammatory response. New strategies, including cell savers and direct thrombin inhibitors, may now fully prevent thrombin generation and fibrinolysis during cardiac surgery.

Area of Science:

  • Biochemistry
  • Immunology
  • Hematology

Background:

  • Cardiopulmonary bypass (CPB) initiates a systemic inflammatory response involving blood cells and plasma proteins.
  • This response generates vasoactive substances, signaling molecules, and alters cellular receptors.
  • Thrombin, a key enzyme in coagulation, is only partially inhibited by heparin during CPB.

Purpose of the Study:

  • To explore the mechanisms of thrombin generation during CPB.
  • To evaluate the potential of novel strategies to completely suppress thrombin and fibrinolysis.

Main Methods:

  • Review of coagulation pathways (extrinsic and intrinsic) and platelet activation during CPB.
  • Analysis of the role of cell savers and direct thrombin inhibitors.

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Main Results:

  • Thrombin is produced via both extrinsic and intrinsic pathways and by activated platelets during CPB.
  • Cell savers and direct thrombin inhibitors present an opportunity for complete thrombin suppression.

Conclusions:

  • Complete suppression of thrombin production and fibrinolysis during CPB is now feasible.
  • This could mitigate the inflammatory and thrombotic consequences of CPB in cardiac surgery.