Fibrinolytic activity and bleeding after cardiac surgery with cardiopulmonary bypass and low-dose aprotinin therapy

Frank Kuepper, George Dangas, Ansgar Mueller-Chorus, Peter M. Kulka, Michael Zenz, Albrecht Wiebalck

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Low-dose aprotinin inhibits hyperfibrinolysis in cardiac surgery. However, excessive postoperative bleeding and increased fibrinolysis may occur despite low dose-aprotinin administration. We investigated (i) whether fibrinolytic activity significantly rises under low-dose aprotinin administration, and (ii) whether this is associated with excessive postoperative bleeding (≥ 1000 ml/24 h). In a prospective single-blind trial, 120 consecutive patients were randomized to receive 280 mg aprotinin or no aprotinin before skin incision. D-dimer levels increased significantly to the end of surgery, reaching higher levels in the control group. The risk for excessive bleeding was lower in the aprotinin group (12 versus 37%, P = 0.001). Fifteen minutes after heparin reversal, patients were at risk for excessive bleeding, when enhanced fibrinolysis was documented (aprotinin group, D-dimer ≥ 1.0 μg/ml, odds ratio = 9.1, P = 0.047; control group, D-dimer ≥ 3.0 μg/ml, odds ratio = 4.6, P = 0.014). Ninety-seven per cent of the aprotinin group and 81% of control group patients had no excessive bleeding when the D-dimer plasma level was below these values. We conclude that (i) fibrinolytic activity significantly rises under low-dose aprotinin administration, and (ii) plasma D-dimer levels at end of surgery may help to identify patients who are unlikely to develop excessive postoperative bleeding.

Original languageEnglish
Pages (from-to)147-153
Number of pages7
JournalBlood Coagulation and Fibrinolysis
Volume14
Issue number2
DOIs
StatePublished - Feb 2003
Externally publishedYes

Keywords

  • Bleeding complications
  • Cardiac surgery
  • Cardiopulmonary bypass
  • D-dimers
  • Fibrinolysis
  • Hyperfibrinolysis
  • Low-dose aprotinin

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