FREQUENCY OF INCREASED FIBRINOLYSIS AFTER CORONARY ARTERY BYPASS GRAFTING

Objective: To determine the frequency of increased fibrinolysis after coronary artery bypass grafting (CABG). Study Design: Descriptive study. Place and Duration of Study: One year duration conducted in the Department of Pathology, Army Medical College in collaboration with Armed Forces Institute of Cardiology (AFIC) from December 2013 to November 2014. Material and Methods: Sixty patients were selected who were admitted to AFIC for CABG surgery. Venous samples were drawn from the patients immediately after surgery when the patients were shifted to post operative ward. Patients were selected by non probability purposive sampling technique. D-dimers were analysed by rapid agglutination assay. Results: Out of 60 patients included in the study, 50 (83.3%) were males and 10 (16.7%) were females. Ddimers level more than 200ng/ml were considered to show increased fibrinolysis. Raised D-dimers were present in 40 (66.6 %) patients while they were normal in 20 (33.3 %) patients.Twenty (33.3%) patients had Ddimers<200ng/ml, 27 (45%) patients had D-dimers between 200-400ng/ml, 7 (11.7%) patients had D-dimers between 400-800ng/ml and 6 (10%) had D-dimers between 800-1600ng/ml. Conclusion: Increased fibrinolysis was present in 40 (66.7%) patients. It is more common in older age than younger ones.

[1]  G. Despotis,et al.  Anticoagulation and anticoagulation reversal with cardiac surgery involving cardiopulmonary bypass: an update. , 1999, Journal of cardiothoracic and vascular anesthesia.

[2]  J. Caprini,et al.  Decreased Platelet Number and Function and Increased Fibrinolysis Contribute to Postoperative Bleeding in Cardiopulmonary Bypass Patients , 1988, Thrombosis and Haemostasis.

[3]  C. von Heymann,et al.  Costs of excessive postoperative hemorrhage in cardiac surgery. , 2009, The Journal of thoracic and cardiovascular surgery.

[4]  H. Philippou,et al.  Mechanisms of thrombin generation during surgery and cardiopulmonary bypass [see comments] , 1993 .

[5]  S. Robinson Activation of Hemostasis After Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass , 2005 .

[6]  S. Z. Zhao,et al.  INTERVENTIONAL CARDIOLOGY AND SURGERY Adverse events in coronary artery bypass graft (CABG) trials: a systematic review and analysis , 2003 .

[7]  M. Goldman Pharmacological strategies to decrease excessive blood loss in cardiac surgery: A meta-analysis of clinically relevant endpoints , 2000 .

[8]  H. Fawzy,et al.  Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial , 2009, Journal of cardiothoracic surgery.

[9]  R. Kalil,et al.  A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting. , 2006, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[10]  E. Bozkurt,et al.  Distribution of coronary artery risk factors: a regional analysis , 2011, Turkish Journal of Medical Sciences.

[11]  O. Dale,et al.  Single-Dose Tranexamic Acid Reduces Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Until Surgery , 2003, Anesthesia and analgesia.

[12]  O. Alfieri,et al.  Activation of Coagulation and Fibrinolysis during Coronary Surgery: On-pump versus Off-pump Techniques , 2001, Anesthesiology.

[13]  M. Yacoub,et al.  Activation of coagulation and fibrinolysis during cardiothoracic operations. , 1998, The Annals of thoracic surgery.

[14]  J. Andreasen,et al.  Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[15]  D. Mangano,et al.  The ongoing variability in blood transfusion practices in cardiac surgery , 2008, Transfusion.

[16]  M. Ray,et al.  Relationship of fibrinolysis and platelet function to bleeding after cardiopulmonary bypass , 1994, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[17]  S. Lydersen,et al.  Increased Fibrinolysis and Platelet Activation in Elderly Patients Undergoing Coronary Bypass Surgery , 2006, Anesthesia and analgesia.