Managing fibrinolysis without aprotinin

The Annals of Thoracic Surgery
L Henry Edmunds

Abstract

Cardiopulmonary bypass increases perioperative bleeding and produces a consumptive coagulopathy, which is defined as the simultaneous production of thrombin and fibrinolysis. Thrombin formation and fibrinolysis primarily occur in the surgical wound and peak at the time heparin is reversed by protamine. Neither aprotinin nor lysine analogs successfully control bleeding in many complex procedures, reoperations, aortic resections, or in implantations of mechanical circulatory devices. This analysis reviews the mechanisms involved and current treatment protocols, with the conclusion that changes in treatment protocols rather than use of a specific anti-fibrinolytic drug may provide better control of bleeding in these patients.

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Citations

May 16, 2013·The Annals of Thoracic Surgery·Marco RanucciUNKNOWN Surgical and Clinical Outcome Research (SCORE) Group
Dec 19, 2012·The Annals of Thoracic Surgery·Shao-Feng ZhouHazim J Safi
Mar 15, 2011·The Annals of Thoracic Surgery·Domenico PaparellaLuigi de Luca Tupputi Schinosa
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Jul 18, 2020·Clinical Hemorheology and Microcirculation·Li ZhaoXian-Jun Ma
May 10, 2017·Interactive Cardiovascular and Thoracic Surgery·Domenico PaparellaRuggero Rociola

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