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Schoerghuber, M; Bärnthaler, T; Prüller, F; Mantaj, P; Cvirn, G; Toller, W; Klivinyi, C; Mahla, E; Heinemann, A.
Supplemental fibrinogen restores thrombus formation in cardiopulmonary bypass-induced platelet dysfunction ex vivo.
Br J Anaesth. 2023; 131(3):452-462 Doi: 10.1016/j.bja.2023.03.010 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz
Bärnthaler Thomas
Schörghuber Michael
Co-Autor*innen der Med Uni Graz
Cvirn Gerhard
Heinemann Akos
Klivinyi Christoph
Mahla Elisabeth
Mantaj Polina
Prüller Florian
Toller Wolfgang
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Abstract:
BACKGROUND: Major cardiac surgery related blood loss is associated with increased postoperative morbidity and mortality. Platelet dysfunction is believed to contribute to post-cardiopulmonary bypass (CPB)-induced microvascular bleeding. We hypothesised that moderately hypothermic CPB induces platelet dysfunction and that supplemental fibrinogen can restore in vitro thrombus formation. METHODS: Blood from 18 patients, undergoing first-time elective isolated aortic valve surgery was drawn before CPB, 30 min after initiation of CPB, and after CPB and protamine administration, respectively. Platelet aggregation was quantified by optical aggregometry, platelet activation by flow-cytometric detection of platelet surface expression of P-selectin, annexin V, and activated glycoprotein IIb/IIIa, thrombus formation under flow and effect of supplemental fibrinogen (4 mg ml-1) on in vitro thrombogenesis. RESULTS: Post-CPB adenosine-diphosphate and TRAP-6-induced aggregation decreased by 40% and 10% of pre-CPB levels, respectively (P<0.0001). Although CPB did not change glycoprotein IIb/IIIa receptor expression, it increased the percentage of unstimulated P-selectin (1.2% vs 7%, P<0.01) positive cells and annexin V mean fluorescence intensity (15.5 vs 17.2, P<0.05), but decreased percentage of stimulated P-selectin (52% vs 26%, P<0.01) positive cells and annexin V mean fluorescence intensity (508 vs 325, P<0.05). Thrombus area decreased from 6820 before CPB to 5230 after CPB (P<0.05, arbitrary units [a.u.]). Supplemental fibrinogen increased thrombus formation to 20 324 and 11 367 a.u. before CPB and after CPB, respectively (P<0.001), thereby restoring post-CPB thrombus area to levels comparable with or higher than pre-CPB baseline. CONCLUSIONS: Single valve surgery using moderately hypothermic CPB induces partial platelet dysfunction. Thrombus formation was restored in an experimental study design by ex vivo supplementation of fibrinogen.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Cardiopulmonary Bypass - adverse effects
P-Selectin - pharmacology
Fibrinogen - administration & dosage
Annexin A5 - pharmacology
Platelet Aggregation - administration & dosage
Hemostatics - administration & dosage
Thrombosis - etiology

Find related publications in this database (Keywords)
cardiac surgery
cardiopulmonary bypass
coagulopathy
fibrinogen
platelet dysfunction
thrombus
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