Fibrinolysis During and After Extracorporeal Circulation

Abstract

Although continued bleeding is no longer a major problem in the postoperative phase of patients undergoing extracorporeal circulation, blood loss is greater than that following other comparable thoracic surgical procedures and remains a matter of concern. Various aspects of control of blood coagulation after perfusion have received detailed attention without any single factor in the coagulation mechanism being identified as a principal cause of such difficulty. Von Kaulla and Swan^16,17 reported observing some degree of fibrinolysis postoperatively in patients undergoing total body perfusion, noting that this was seldom pronounced but in some cases might be fatal. These investigators believed the degree of activation was related to factors such as efficiency of perfusion and degree of postoperative acidosis. Others have also noted postoperative fibrinolysis,^11,12 but relatively little specific information has been reported or evidence obtained indicating the precipitating mechanism. In an attempt to document further the incidence of abnormal