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Open Access Research article

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass

Agnese Ozolina1*, Eva Strike12, Inta Jaunalksne3, Angelika Krumina4, Lars J Bjertnaes56 and Indulis Vanags2

Author Affiliations

1 Department of Anaesthesiology and Cardiac surgery, Pauls Stradins Clinical University Hospital, Pilsonu street 13, Riga, Latvia

2 Department of Anaesthesiology and Reanimatology, Riga Stradins University, Dzirciema street 16, Riga, Latvia

3 Clinical Immunology Centre, Pauls Stradins Clinical University Hospital, Pilsonu street 13, Riga, Latvia

4 Department of Infectology and Dermatology, Riga Stradins University, Dzirciema street 16, Riga, Latvia

5 Anaesthesia and Critical Care Research Group, Department of Clinical Medicine (Anaesthesiology), Faculty of Medicine, University of Tromsø, MH-Breivika, Tromsø, 9038, Norway

6 Department of Anaesthesiology, University Hospital of North Norway, Sykehusveien 38, Tromsø, 9038, Norway

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BMC Anesthesiology 2012, 12:27  doi:10.1186/1471-2253-12-27

Published: 30 October 2012

Abstract

Background

Enhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor – 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding.

Methods

Totally 88 adult patients (mean age 66 ± 10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ≤ 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS.

Results

Nine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = − 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P < 0.001 and P = 0.012, respectively). Group I displayed significantly lower plasma concentrations of fibrinogen and higher levels of D-dimer from immediately after the operation and throughout the first 24 hours postoperatively.

Conclusions

Lower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery.

Keywords:
Cardiac surgery; Fibrinolysis; Plasminogen activator inhibitor; Tissue plasminogen activator