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Ann Thorac Surg 2010;89:324-331. doi:10.1016/j.athoracsur.2009.10.043
© 2010 The Society of Thoracic Surgeons
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Reviews

Managing Fibrinolysis Without Aprotinin

L. Henry Edmunds, Jr, MD*

Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

* Address correspondence to Dr Edmunds, Department of Surgery, University of Pennsylvania School of Medicine, 3440 Market St, Suite 306, Philadelphia, PA 19104-3325 (Email: hank.edmunds{at}uphs.upenn.edu).

Cardiopulmonary bypass increases perioperative bleeding and produces a consumptive coagulopathy, which is defined as the simultaneous production of thrombin and fibrinolysis. Thrombin formation and fibrinolysis primarily occur in the surgical wound and peak at the time heparin is reversed by protamine. Neither aprotinin nor lysine analogs successfully control bleeding in many complex procedures, reoperations, aortic resections, or in implantations of mechanical circulatory devices. This analysis reviews the mechanisms involved and current treatment protocols, with the conclusion that changes in treatment protocols rather than use of a specific anti-fibrinolytic drug may provide better control of bleeding in these patients.




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