Tranexamic acid leads to paradoxical coagulation changes during cardiac surgery: a pilot rotational thromboelastometry study

Journal of Surgical Research

Volumn 217, Issue , 2017, Pages 100-112

  Sharma, Rajiv ^a,b   Letson, Hayley L ^a   Smith, Samuel ^a   Dobson, Geoffrey P ^a  

^a JAMES COOK UNIVERSITY   (Australia)

^b Mater Hospital   (Australia)

Author keywords

Antifibrinolytic; Cardiac surgery; Cardiopulmonary bypass; coagulation; Trauma; TXA

Indexed keywords

FIBRINOGEN; PROTAMINE; TRANEXAMIC ACID; ANTIFIBRINOLYTIC AGENT;

ADULT; AGED; ARTICLE; BLOOD CLOT LYSIS; BLOOD CLOTTING; BLOOD CLOTTING PARAMETERS; BLOOD CLOTTING TIME; BLOOD EXAMINATION; CARDIOPULMONARY BYPASS; CLINICAL ARTICLE; CLOT FIRMNESS; CLOT STRENGTH; CONTROLLED STUDY; FIBRINOLYSIS; HEPARINIZATION; HUMAN; MALE; PILOT STUDY; PRIORITY JOURNAL; ROTATIONAL THROMBOELASTOMETRY; STERNOTOMY; THROMBOCYTE COUNT; ADVERSE EFFECTS; DRUG EFFECTS; HEART SURGERY; HEMORRHAGE; MIDDLE AGED; PROCEDURES; STATISTICS AND NUMERICAL DATA; THROMBOELASTOGRAPHY;

AGED; ANTIFIBRINOLYTIC AGENTS; BLOOD COAGULATION; CARDIAC SURGICAL PROCEDURES; HEMORRHAGE; HUMANS; MALE; MIDDLE AGED; PILOT PROJECTS; THROMBELASTOGRAPHY; TRANEXAMIC ACID;

EID: 85020317629     PISSN: 00224804     EISSN: 10958673     Source Type: Journal    
DOI: 10.1016/j.jss.2017.05.006     Document Type: Article

References (33)

1. Sniecinski, R.M., Chandler, W.L., Activation of the hemostatic system during cardiopulmonary bypass. Anesth Analg 113 (2011), 1319–1333.
2. Murphy, G.J., Reeves, B.C., Rogers, C.A., Rizvi, S.I., Culliford, L., Angelini, G.D., Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 116 (2007), 2544–2552.
3. Koster, A., Faraoni, D., Levy, J.H., Antifibrinolytic therapy for cardiac surgery: an update. Anesthesiology 123 (2015), 214–221.
4. Eisses, M.J., Velan, T., Aldea, G.S., Chandler, W.L., Strategies to reduce hemostatic activation during cardiopulmonary bypass. Thromb Res 117 (2006), 689–703.
5. Dobson, G.P., Addressing the global burden of trauma in major surgery. Front. Surg, 2, 2015, 43.
6. Kehara, H., Takano, T., Ohashi, N., Terasaki, T., Amano, J., Platelet function during cardiopulmonary bypass using multiple electrode aggregometry: comparison of centrifugal and roller pumps. Artif Organs 38 (2014), 924–930.
7. Roberts, I., Tranexamic acid in trauma: how should we use it?. J Thromb Haemost 13 (2015), S195–S199.
8. Myles, P.S., Smith, J.A., Forbes, A., et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 376 (2017), 136–148.
9. Fergusson, D.A., Hébert, P.C., Mazer, C.D., et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 358 (2008), 2319–2331.
10. McMullan, V., Alston, R.P., Aprotinin and cardiac surgery: a sorry tale of evidence misused. Br J Anaesth 110 (2013), 675–678.
11. Napolitano, L.M., Cohen, M.J., Cotton, B.A., Schreiber, M.A., Moore, E.E., Tranexamic acid in trauma: how should we use it?. J Trauma Acute Care Surg 74 (2013), 1575–1586.
12. Harvey, R., Salehi, A., Con: antifibrinolytics should not be used routinely in low-risk cardiac surgery. J Cardiothorac Vasc Anesth 30 (2016), 248–251.
13. Binz, S., McCollester, J., Thomas, S., et al. CRASH-2 study of tranexamic acid to treat bleeding in trauma patients: a controversy fueled by science and social media. J Blood Transfus, 2015, 2015, 874920.
14. Nielsen, V.G., Coagulation crystal ball: why can't we predict bleeding after cardiac surgery?. Anesth Analg 115 (2012), 490–493.
15. Bolliger, D., Tanaka, K.A., Roles of thrombelastography and thromboelastometry for patient blood management in cardiac surgery. Transfus Med Rev 27 (2013), 213–220.
16. Solomon, C., Ranucci, M., Hochleitner, G., Schöchl, H., Schlimp, C.J., Assessing the methodology for calculating platelet contribution to clot strength (platelet component) in thromboelastometry and thrombelastography. Anesth Analg 121 (2015), 868–878.
17. Nashef, S.A.M., Roques, F., Gauducheau, M.E., Lemeshow, S., Salamon, R., European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16 (1999), 9–13.
18. Geissler, H.J., Hölzl, P., Marohl, S., et al. Risk stratification in heart surgery: comparison of six score systems. Eur J Cardiothorac Surg 17 (2000), 400–406.
19. Mittermayr, M., Velik-Salchner, C., Stalzer, B., et al. Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM®): results of a pilot study. Anesth Analg 108 (2009), 743–750.
20. Letson, H.L., Dobson, G.P., Correction of acute traumatic coagulopathy with small-volume 7.5% NaCl adenosine, lidocaine and Mg2+ (ALM) occurs within 5 min: a ROTEM analysis. J Trauma Acute Care Surg 78 (2015), 773–783.
21. Meesters, M.I., Lance, M.D., Van der Berg, R., Boer, C., The value of the thromboelastometry heparinase assay (HEPTEM) in cardiac surgery. Thromb Haemost 114 (2015), 1058–1063.
22. Lang, T., Bauters, A., Braun, S., et al. Multi-centre investigation on reference ranges for ROTEM thromboelastometry. Blood Coagul Fibrinolysis 16 (2005), 301–310.
23. Dobson, G.P., Letson, H.L., Sharma, R., Sheppard, F., Cap, A.P., Mechanisms of early traumatic-induced coagulopathy (TIC): the clot thickens or not?. J Trauma Acute Care Surg 79 (2015), 301–309.
24. Weisel, J.W., Litvinov, R.I., Fibrin formation, structure and properties. Subcell Biochem 82 (2017), 405–456.
25. Mullin, J.L., Gorkun, O.V., Binnie, C.G., Lord, S.T., Recombinant fibrinogen studies reveal that thrombin specificity dictates order of fibrinopeptide release. J Biol Chem 275 (2000), 25239–25246.
26. Mosesson, M.W., Fibrinogen and fibrin structure and functions. J Thromb Haemost 3 (2005), 1894–1904.
27. Arni, R.K., Padmanabhan, K., Padmanabhan, K.P., Wu, T.P., Tulinsky, A., Structure of the non-covalent complex of prothrombin kringle 2 with PPACK-thrombin. Chem Phys Lipids 67-68 (1994), 59–66.
28. O'Carroll-Kuehn, B.U., Meeran, H., Management of coagulation during cardiopulmonary bypass. Contin Educ Anaesth Crit Care Pain 7 (2007), 195–198.
29. Jaques, L.B., Protamine–antagonist to heparin. Can Med Assoc J 108 (1973), 1291–1297.
30. Ni Ainle, F., Preston, R.J., Jenkins, P.V., et al. Protamine sulfate down-regulates thrombin generation by inhibiting factor V activation. Blood 114 (2009), 1658–1665.
31. Selleng, S., Malowsky, B., Strobel, U., et al. Early-onset and persisting thrombocytopenia in post-cardiac surgery patients is rarely due to heparin-induced thrombocytopenia, even when antibody tests are positive. J Thromb Haemost 8 (2010), 30–36.
32. Cuker, A., Cines, D.B., Protamine-induced thrombocytopenia?. Blood 121 (2013), 2818–2819.
33. Singla, A., Sullivan, M.J., Lee, G., et al. Protamine-induced immune thrombocytopenia. Transfusion 53 (2013), 2158–2163.