Systematic Elucidation of Effects of Tranexamic Acid on Fibrinolysis and Bleeding During and After Cardiopulmonary Bypass Surgery
| Autor: | Satoshi Gando, Hideyuki Mashio, Yukiko Goda, Hiroshi Kawahigashi, Osamu Kemmotsu, Taku Kojima, Yuji Morimoto |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Male
Antifibrinolytic medicine.drug_class medicine.medical_treatment law.invention Fibrin Fibrinogen Degradation Products chemistry.chemical_compound law Plasminogen Activator Inhibitor 1 D-dimer Fibrinolysis medicine Cardiopulmonary bypass Humans Fibrinolysin alpha-2-Antiplasmin Cardiopulmonary Bypass business.industry Hematology Perioperative Middle Aged Antifibrinolytic Agents Hemostasis Surgical Tranexamic Acid chemistry Tissue Plasminogen Activator Plasminogen activator inhibitor-1 Anesthesia Female business Plasminogen activator Tranexamic acid medicine.drug |
| Zdroj: | Thrombosis Research. 104:301-307 |
| ISSN: | 0049-3848 |
| DOI: | 10.1016/s0049-3848(01)00379-6 |
| Popis: | The aim of this study was to systematically elucidate the effects of tranexamic acid on fibrinolysis and bleeding during and after cardiopulmonary bypass (CPB) surgery. Twenty-two patients undergoing CPB surgery were randomized to receive 100 mg/kg tranexamic acid or an equal volume of saline after anesthesia induction and prior to skin incision. Plasma levels of tissue plasminogen activator (t-PA) antigen and activity, crosslinked fibrin degradation products (D-dimer), α2-antiplasmin–plasmin complex, and plasminogen activator inhibitor-1 (PAI-1) antigen were measured. Blood samples were obtained after induction of anesthesia, before, during, and after CPB, at the end of surgery, and the next morning after surgery. Intraoperative and postoperative blood loss during 24 h after surgery was recorded. Patients' demographics were similar between the two groups. No patients suffered from thrombotic complications after surgery. In the tranexamic acid group, fibrinolytic activity and secondary fibrinolysis as measured by t-PA activity and D-dimer were markedly suppressed during CPB surgery ( P =.042 and P =.015, respectively). Decreased fibrinolytic activity and fibrinolysis were accompanied by reduction of perioperative bleeding in the tranexamic acid group. We could also find a good positive correlation between the peak levels of t-PA activity and D-dimer ( r 2 =.4203, P =.0011). No differences in the t-PA antigen, PAI-1 antigen release, and plasmin inhibition by α2-antiplasmin were apparent between the two groups. In a randomized, prospective trial of patients undergoing CPB surgery, we demonstrated that the synthetic antifibrinolytic drug tranexamic acid effectively suppresses fibrinolysis by inhibiting t-PA and plasmin activity with clear reduction of perioperative blood loss. While tranexamic acid had no effects on the other important fibrinolytic inhibitors like PAI-1 and α2-antiplasmin. |
| Databáze: | OpenAIRE |
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