Managing Fibrinolysis Without Aprotinin

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Managing Fibrinolysis Without Aprotinin L. Henry Edmunds, MD The Annals of Thoracic Surgery Volume 89, Issue 1, Pages 324-331 (January 2010) DOI: 10.1016/j.athoracsur.2009.10.043 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Serial measurements of prothrombin fragment, F1.2, during cardiopulmonary bypass. (ECC = duration of cardiopulmonary bypass; H = heparin injection; P = protamine administration; S = duration of operation.) (Reprinted from Boisclair MD, Lane DA, Philippou H. Mechanisms of thrombin generation during surgery and cardiopulmonary bypass. Blood 1993;82:3350–7 [17], with permission. © The American Society of Hematology.) (B) Ten serial measurements of d-dimer during cardiac surgery with cardiopulmonary bypass (CPB) (black bar). Protamine was given at sample 9; sample 10 was taken two hours later. (Reprinted from Chandler WL, Valen T. Plasmin generation and d-dimer formation during cardiopulmonary bypass. Blood Coag Fibroly 2004;15:583–91 [26], with permission.) The Annals of Thoracic Surgery 2010 89, 324-331DOI: (10.1016/j.athoracsur.2009.10.043) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Concentrations of F1.2, taken from the perfusion circuit during cardiac surgery. Thirty to 45 minutes after beginning cardiopulmonary bypass (CPB), simultaneous samples were drawn from the pericardial well surrounding the heart (PERC) and the circuit (PERF). (HEP = heparin injection; POST = immediately after CPB stopped; PROT at the time of protamine administration.) (Reprinted from Chung JH, Gikakis N, Drake TA, Colman RW, Edmunds LH Jr. Pericardial blood activates the extrinsic coagulation pathway during clinical cardiopulmonary bypass. Circulation 1996;93:2014–2018 [29], with permission.) (B) Simultaneous measurements of fibrinogen degradation products (FgDP), fibrin degradation products (FbDP), and tissue-type plasminogen activating factor drawn from the perfusion circuit (black bars) and from the wound (gray bars). (Reprinted from Tabuchi N, Haan J, Boonstra PW, van Oeveren W. Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993;106:828–33 [37], with permission.) The Annals of Thoracic Surgery 2010 89, 324-331DOI: (10.1016/j.athoracsur.2009.10.043) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions