Kardiyopulmoner Bypass Esnasında Antikoagülan Kullanımı Mikrotrombüs Oluşumunu Tam Olarak Engelliyor mu?
Abstract
Amaç: Bu çalışmada, kardiyopulmoner bypass esnasında heparin
kullanımının mikrotrombüs oluşumunu tam olarak engelleyip engellemediği incelenmiştir.
Materyal ve Metod: Açık kalp cerrahisi yapılan 42 hastada anestezi
indüksiyonu öncesi, kardiyopulmoner bypass (KPB) başladıktan yarım saat sonra,
sternum kapatıldıktan sonra ve postoperatif 1. günde faktör II, V, VII, X,
antitrombin-III, protein C, protein S, fibrinojen, d-dimer, PT, aPTT ve
hemogram için kan örnekleri alınarak koagulasyon sistemi değerlendirildi.
Ayrıca karaciğer ve böbrek fonksiyonları ile nörokognitif fonksiyonlar
değerlendirildi.
Bulgular: FII, FV, FVII, FX, AT III ve protein C değerleri KPB
esnasında preoperatif değerine göre anlamlı olarak düşmekte, daha sonra yavaş
yavaş yükselmekteydi. Protein S değeri
ise KPB esnasında anlamlı olarak yükselmekte ve sonra preoperetif değerlerine
inmekteydi. Fibrinojen seviyeleri dalgalı olarak seyrederken D dimer, PT ve
aPTT değerleri KPB esnasında yükselmekteydi. Hemoglobin, hematokrit ve
trombosit değerleri de KPB esnasında düşmekte, sonra yavaş yavaş
yükselmekteydi. Hastalarda belirgin bir böbrek veya karaciğer fonksiyon
bozukluğu ve nörokognitif fonksiyonlarda bozukluk saptanmadı.
Sonuç: KPB esnasında koagulasyon
faktörlerinin azalmakta ve ardından yükselmesinin hemodilüsyona bağlı olabileceği
düşünülebilir. Ancak D dimer seviyelerindeki artış, KPB esnasında bir trombüs
oluşumu meydana geldiğini göstermektedir. Ancak bu trombüs oluşumu klinik
olarak anlamlı değildir.
References
- 1. Tanaka K, Takao M, Yada I, Yuasa H, Kusagawa M, Deguchi K. Alterations in coagulation and fibrinolysis associated with cardiopulmonary bypass during open heart surgery. J Cardiothorac Anesth. 1989; 3: 181-8.
- 2. Dietrich W. Reducing thrombin formation during cardiopulmonary bypass: is there a benefit of the additional anticoagulant action of aprotinin? J Cardiovasc Pharmacol. 1996; 27 Suppl 1: S50-7
- 3. Videm V, Svennevig JL, Fosse E, Semb G, Osterud A, Mollnes TE. Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. J Thorac Cardiovasc Surg 1992; 103: 806-13.
- 4. Bevilacqua MP, Pober JS, Majeau GR, Fiers W, Cotran RS, Gimbrone MA. Recombinant tumor necrosis factor induces procoagulant activity in cultured human vascular endothelium: characterization and comparison with the action of interleukin 1. Proc Natl Acad Sci 1986; 83: 4533-7.
- 5. Harker LA, Malpass TW, Branson HE, Hessel EA, Slichter SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selective alpha granule release. Blood 1980; 56: 824-34.6. Phillis JW. Adenosine in the control of the cerebral circulation. Cerebrovasc Brain Metab Rev, 1989;1: 26-54.
- 7. Somson S, Shore-Lesserson L. Platelet functeon and cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth 2001; 5: 273-81.
- 8. Hashimoto K, Yamagishi M, Sasaki T, Nakano M, Kurosawa H. Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation. Ann Thorac Surg., 1994; 58: 799-804
- 9. Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood 1990; 76: 1680-97.
- 10. Matsuo T, Kobayashi H, Kario K, Suzuki S. Fibrin D dimer in thrombogenic disorders. Semin Thromb Hemos 2000; 26: 101-7.
Does the Use of Anticoagulants During Cardiopulmonary Bypass Prevent Microthrombosis Formation Completely?
Abstract
Aim:
This study examined whether heparin use during cardiopulmonary bypass
(CBP) completely prevents microthrombus formation.
Materials and Methods: The coagulation systems of 42 patients undergoing
open heart surgery were evaluated by collecting blood specimens for factor (F)
II, V, VII, and X, antithrombin-III (AT-III), protein C, protein S, fibrinogen,
D-dimer, PT, aPTT and complete blood count investigation before induction of
anesthesia, half an hour after start of CBP, following sternum closure and on
postoperative day 1. Liver, kidney and neurocognitive functions were also
evaluated.
Results: FII, FV, FVII, FX, AT-III and
protein C values decreased significantly during CBP compared to preoperative
values, and then gradually increased. Protein S values increased significantly
during CBP and subsequently decreased to preoperative levels. Fibrinogen levels
fluctuated, while D-dimer, PT ve aPTT increased during CBP. Hemoglobin,
hematocrit and platelet values also decreased during CBP, and then rose
gradually. No significant kidney, liver or neurocognitive function impairment
was determined.
Conclusion: Coagulation factors decreasing during CBP and then
rising may be related to hemodilution. However, the increase in D-dimer shows
that thrombus formation occurs during CBP, although this is not clinically
significant
References
- 1. Tanaka K, Takao M, Yada I, Yuasa H, Kusagawa M, Deguchi K. Alterations in coagulation and fibrinolysis associated with cardiopulmonary bypass during open heart surgery. J Cardiothorac Anesth. 1989; 3: 181-8.
- 2. Dietrich W. Reducing thrombin formation during cardiopulmonary bypass: is there a benefit of the additional anticoagulant action of aprotinin? J Cardiovasc Pharmacol. 1996; 27 Suppl 1: S50-7
- 3. Videm V, Svennevig JL, Fosse E, Semb G, Osterud A, Mollnes TE. Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. J Thorac Cardiovasc Surg 1992; 103: 806-13.
- 4. Bevilacqua MP, Pober JS, Majeau GR, Fiers W, Cotran RS, Gimbrone MA. Recombinant tumor necrosis factor induces procoagulant activity in cultured human vascular endothelium: characterization and comparison with the action of interleukin 1. Proc Natl Acad Sci 1986; 83: 4533-7.
- 5. Harker LA, Malpass TW, Branson HE, Hessel EA, Slichter SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selective alpha granule release. Blood 1980; 56: 824-34.6. Phillis JW. Adenosine in the control of the cerebral circulation. Cerebrovasc Brain Metab Rev, 1989;1: 26-54.
- 7. Somson S, Shore-Lesserson L. Platelet functeon and cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth 2001; 5: 273-81.
- 8. Hashimoto K, Yamagishi M, Sasaki T, Nakano M, Kurosawa H. Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation. Ann Thorac Surg., 1994; 58: 799-804
- 9. Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood 1990; 76: 1680-97.
- 10. Matsuo T, Kobayashi H, Kario K, Suzuki S. Fibrin D dimer in thrombogenic disorders. Semin Thromb Hemos 2000; 26: 101-7.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Makaleler |
| Authors | |
| Publication Date | March 11, 2018 |
| Submission Date | February 5, 2018 |
| Acceptance Date | February 21, 2018 |
| Published in Issue | Year 2018 Volume: 13 Issue: 1 |
