Skip to main content
SpringerLink
Log in

Plasmin Generation and Fibrinolysis in Pediatric Patients Undergoing Cardiopulmonary Bypass Surgery

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This prospective, single-centre cohort study aimed to evaluate plasmin generation and fibrinolysis during and after cardiopulmonary bypass (CPB) surgery in a cohort of children up to 6 years of age. Blood samples were drawn at eight time points: after induction of anesthesia, before unfractionated heparin (UFH), after UFH, after initiation of bypass, before protamine, after protamine, after chest closure, and 6 h after chest closure. The study identified an increase in fibrinolysis during CPB and particularly up to 6 h afterward in children. This could be the mechanism for the significant bleeding events observed in this young population after CPB. This study establishes the foundation for future studies in this area, particularly those focusing on clinical outcomes after CPB surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Andrew M, Paes B, Johnston M (1990) Development of the hemostatic system in the neonate and young infant. Blood 12:95–104

    CAS  Google Scholar 

  2. Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM et al (1987) Development of the human coagulation system in the full-term infant. Blood 70:165–172

    PubMed  CAS  Google Scholar 

  3. Bouma BN, Mosnier LO (2006) Thrombin activatable fibrinolysis inhibitor (TAFI): How does thrombin regulate fibrinolysis? Ann Med 38:378–388

    Article  PubMed  CAS  Google Scholar 

  4. Chan AK, Leaker M, Burrows FA, Williams WG, Gruenwald CE, Whyte L, Adams M, Brooker LA, Adams H, Mitchell L, Andrew M (1997) Coagulation and fibrinolytic profile of paediatric patients undergoing cardiopulmonary bypass. Thromb Haemost 77:270–277

    PubMed  CAS  Google Scholar 

  5. Chandler WL (2005) Effects of hemodilution, blood loss, and consumption on hemostatic factor levels during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 19:459–467

    Article  PubMed  Google Scholar 

  6. Corrigan JJ Jr, Sleeth JJ, Jeter M, Lox CD (1989) Newborn’s fibrinolytic mechanism: components and plasmin generation. Am J Hematol 32:273–278

    Article  PubMed  CAS  Google Scholar 

  7. Davies LK (1999) Cardiopulmonary bypass in infants and children: How is it different? J Cardiothorac Vasc Anesth 13:330–345

    Article  PubMed  CAS  Google Scholar 

  8. Dietrich W, Dilthey G, Spannagl M, Jochum M, Braun SL, Richter JA (1995) Influence of high-dose aprotinin on anticoagulation, heparin requirement, and celite- and kaolin-activated clotting time in heparin-pretreated patients undergoing open-heart surgery: a double-blind, placebo-controlled study. Anesthesiology 83:679–689

    Article  PubMed  CAS  Google Scholar 

  9. Eisses MJ, Seidel K, Aldea GS, Chandler WL (2004) Reducing hemostatic activation during cardiopulmonary bypass: a combined approach. Anesth Analg 98:1208–1216

    Article  PubMed  Google Scholar 

  10. Guay J, Rivard GE (1996) Mediastinal bleeding after cardiopulmonary bypass in pediatric patients. Ann Thorac Surg 62:1955–1960

    Article  PubMed  CAS  Google Scholar 

  11. Hunt B, Parratt RN, Segal HC, Sheikh S, Kallis P, Yacoub M (1998) Activation of coagulation and fibrinolysis during cardiothoracic operations. Ann Thorac Surg 65:712–718

    Article  PubMed  CAS  Google Scholar 

  12. Ignjatovic V, Than J, Summerhayes R, Newall F, Horton S, Cochrane A, Monagle P (2011) Hemostatic response in paediatric patients undergoing cardiopulmonary bypass surgery. Ped Cardiol 32(5):621–627

    Article  Google Scholar 

  13. Khuri SF, Valeri CR, Loscalzo J, Weinstein MJ, Birjiniuk V, Healey NA, MacGregor H, Doursounian M, Zolkewitz MA (1995) Heparin causes platelet dysfunction and induces fibrinolysis before cardiopulmonary bypass. Ann Thorac Surg 60:1008–1014

    Article  PubMed  CAS  Google Scholar 

  14. Levi M, Cromheecke ME, de Jonge E, Prins MH, de Mol BJ, Briët E, Buller HR (1999) Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 354:1940–1947

    Article  PubMed  CAS  Google Scholar 

  15. Mossinger H, Dietrich W (1998) Activation of hemostasis during cardiopulmonary bypass and pediatric aprotinin dosage. Ann Thorac Surg 65(6 Suppl):S45–S50

    Article  PubMed  CAS  Google Scholar 

  16. Mossinger H, Dietrich W, Braun SL, Jochum M, Meisner H, Richter JA (2003) High-dose aprotinin reduces activation of hemostasis, allogeneic blood requirement, and duration of postoperative ventilation in pediatric cardiac surgery. Ann Thorac Surg 75:430–437

    Article  PubMed  Google Scholar 

  17. Parmar N, Mitchell LG, Berry LR, Andrew M, Chan AK (2006) The influence of age on in vitro plasmin generation in the presence of fibrin monomer. Acta Haematol 115:141–151

    Article  PubMed  CAS  Google Scholar 

  18. Parmar N, Albisetti M, Berry LR, Chan AK (2006) The fibrinolytic system in newborns and children. Clin Lab 52:115–124

    PubMed  CAS  Google Scholar 

  19. Parmar N, Mitchell LG, Berry LR, Andrew M, Chan AK (2006) The influence of age on in vitro plasmin generation in the presence of fibrin monomer. Acta Haematol 115:141–151

    Article  PubMed  CAS  Google Scholar 

  20. Ray MJ, Marsh NA, Hawson GA (1994) Relationship of fibrinolysis and platelet function to bleeding after cardiopulmonary bypass. Blood Coagul Fibrinolysis 5:679–685

    Article  PubMed  CAS  Google Scholar 

  21. Summerhayes R, Ignjatovic V, Hall M, Monagle P (2007) Age-related reference ranges for TAFI and fibrin monomers in healthy children. J Throm Haemost 5(Suppl 2):P-S-397

    Google Scholar 

  22. Teufelsbauer H, Proidl S, Havel M, Vukovich T (1992) Early activation of hemostasis during cardiopulmonary bypass: evidence for thrombin mediated hyperfibrinolysis. Thromb Haemost 68:250–252

    PubMed  CAS  Google Scholar 

  23. Valen G, Eriksson E, Risberg B, Vaage J (1994) Fibrinolysis during cardiac surgery: release of tissue plasminogen activator in arterial and coronary sinus blood. Eur J Cardiothorac Surg 8:324–330

    Article  PubMed  CAS  Google Scholar 

  24. Williams GD, Bratton SL, Ramamoorthy C (1999) Factors associated with blood loss and blood product transfusions: a multivariate analysis in children after open heart surgery. Anesth Analg 89:57–64

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Murdoch Childrens Research Institute, Flemington Road, Parkville, VIC, 3052, Australia

    Vera Ignjatovic, Robyn Summerhayes, Fiona Newall & Paul Monagle

  2. Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Vera Ignjatovic, Robyn Summerhayes, Fiona Newall, Andrew Cochrane & Paul Monagle

  3. Department of Clinical Haematology, Royal Children’s Hospital, Melbourne, Australia

    Aparajith Chandramouli, Jenny Than, Fiona Newall & Paul Monagle

  4. Department of Nursing, The University of Melbourne, Melbourne, Australia

    Fiona Newall

  5. Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Australia

    Steve Horton

  6. Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia

    Andrew Cochrane

Authors
  1. Vera Ignjatovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aparajith Chandramouli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jenny Than
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robyn Summerhayes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fiona Newall
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steve Horton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew Cochrane
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paul Monagle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vera Ignjatovic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ignjatovic, V., Chandramouli, A., Than, J. et al. Plasmin Generation and Fibrinolysis in Pediatric Patients Undergoing Cardiopulmonary Bypass Surgery. Pediatr Cardiol 33, 280–285 (2012). https://doi.org/10.1007/s00246-011-0122-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-011-0122-6

Keywords

Search

Navigation