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Related Experiment Videos

Selected blood coagulation parameters during extracorporeal circulation.

D Schoeffel, K Schimpf, C Krier

    Behring Institute Mitteilungen
    |February 1, 1986
    PubMed
    Summary
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    Open heart surgery using extracorporeal circulation (ECC) significantly alters blood coagulation. A critical risk for disseminated intravascular coagulation (DIC) arises when ECC stops due to high factor XIIa and low C1-inhibitor activity.

    Area of Science:

    • Cardiovascular Surgery
    • Hemostasis and Thrombosis
    • Anesthesiology

    Background:

    • Extracorporeal circulation (ECC) is essential for open heart surgery but significantly impacts hemostasis.
    • Understanding coagulation changes during ECC is crucial for managing surgical risks.
    • Heparin is used during ECC to prevent thrombosis, but its effects are reversed post-procedure.

    Purpose of the Study:

    • To investigate the dynamic changes in selected coagulation parameters during and after open heart surgery with ECC.
    • To identify critical periods and factors contributing to coagulation disorders, such as disseminated intravascular coagulation (DIC).
    • To assess the interplay between coagulation factors, C1-inhibitor, and anticoagulants during ECC.

    Main Methods:

    • Prospective study involving 13 patients undergoing open heart surgery with ECC.

    Related Experiment Videos

  • Serial measurement of coagulation factors (I, II, V, VII, X, XII), C1-inhibitor activity and concentration, antithrombin III, alpha 2-antiplasmin, and platelets.
  • Analysis of coagulation parameter changes during ECC and at its discontinuation.

    • Main Results:

    • Factor XIIa significantly increased (38%) during ECC, posing a risk for intravascular coagulation, counteracted by heparin.
    • C1-inhibitor activity dropped sharply to 12%, exceeding the decrease in its concentration (to 59%).
    • Coagulation factors I, II, V, VII, X, XII, antithrombin III, alpha 2-antiplasmin, and platelets decreased by 50-60%, primarily due to hemodilution.

    Conclusions:

    • The period immediately after ECC discontinuation presents the highest risk for DIC.
    • This heightened risk is attributed to elevated factor XIIa and critically low C1-inhibitor activity, exacerbated by protamine neutralization of heparin.
    • Close monitoring and management of coagulation are essential during the transition from ECC to native circulation.