PubMed · 13987723
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L SEIBEL. 1963. Clotting time.. https://pubmed.ncbi.nlm.nih.gov/13987723/
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The lung vasculature bed has a unique fibrinolytic potential, which has not yet been completely elucidated. We investigated the effect of blood passage through the pulmonary circulation on the values of fibrinolytic parameters in plasma. Forty-seven patients (16 women, 31 men, mean age 54 years, range 21-67 years) who had undergone elective cardiac catheterization were included in the study. The blood samples were taken simultaneously from the right atrium and the left ventricle. The following fibrinolytic parameters were measured: tissue-type plasminogen (t-PA) antigen and activity, plasminogen activator inhibitor-1 (PAI-1) antigen and activity, and euglobulin clot lysis time (ECLT). No difference was found between the samples obtained from the right atrium and the left ventricle with respect to t-PA antigen: 8.1 (6.7-11.3) vs 8.4 (5.9-11.0) ng/ml; t-PA activity: 92 (5-680) vs 62 (32-696) IU/ml; PAI-1 antigen: 8.4 (5.5-14.3) vs 8.7 (6.2-13.1) ng/ml; and ECLT: 5.5 (4.1-9.1) vs 5.6 (4.1-8.5) 1 000/min. In contrast, PAI activity decreased significantly: 7.9 (5.8-10.3) vs 7.4 (6.0-10.4) IU/ml, P < 0.01. Patients with and without pulmonary hypertension did not differ in any of measured parameters, either in the right atrium or in the left ventricle. These results show that under basal conditions fibrinolytic activity which is not attributed to t-PA is elevated in lung vasculature. Further, basal fibrinolytic activity in the lungs is not influenced by pulmonary hypertension.
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STUDY OBJECTIVE: To evaluate a point-of-care (POC) coagulation monitoring analyzer (CoaguChek Pro DM) in patients undergoing cardiopulmonary bypass (CPB). DESIGN: Prospective, blinded study. SETTING: University hospital. PARTICIPANTS: 32 patients scheduled for elective cardiac surgery with CPB. INTERVENTION: Arterial blood samples were drawn four times: preoperatively, postinduction, and 10 minutes and 60 minutes after reversal of heparin with protamine. MEASUREMENTS AND MAIN RESULTS: Activated partial thromboplastin time (aPTT) and prothrombin time (PT) were measured with a point-of-care system--CoaguChek Pro DM as well as with the Core Laboratory facility using a MD180 analyzer. A total of 128 consecutive paired analyses were conducted. There was very good agreement of the point-of-care-based monitoring of aPTT and PT with the Core Laboratory-based monitoring of aPTT and PT (positive correlations by linear regression analysis: r2 = 0.83 and 0.92, respectively). The turn-around time (time from blood sampling until availability of data for the anesthesiologists) was significantly shorter for the point-of-care system (averaging <10 min) than for the Core Laboratory system (averaging >30 min). CONCLUSION: CoaguChek Pro DM is a reliable and time-efficient point-of-care system for monitoring coagulation of patients undergoing CPB. The use of this system may improve patient care in this group through timely and accurate clinical decisions.