Fibrinolysis during cardiac surgeryRelease of tissue plasminogen activator in arterial and coronary sinus blood

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Abstract
Endothelial release of tissue plasminogen activator (t-PA) may initiatefibrinolysis. Fibrinolysis and coagulation were investigated in 12 patientsundergoing elective coronary artery bypass surgery. Cardiopulmonary bypass(CPB) was 108 +/- 7 min (mean +/- SEM), the time of cold, crystalloid,retrograde cardioplegia 53 +/- 5 min. Arterial and coronary sinus bloodwere sampled concomitantly before cardioplegia and after release of theaortic cross-clamp, for measurement of t-PA antigen (Ag) and activity,plasminogen activator inhibitor (PAI-1) Ag and activity, t-PA/PAI-1complex, single chain urokinase (sc-uPA) and urokinase (uPA) plasminogenactivators, the fibrin split product D- dimer, thrombin-antithrombincomplex (TAT), and the prothrombin split product F 1 + 2. Cardiopulmonarybypass significantly increased t-PA Ag and activity, t-PA/PAI complex,D-dimer, TAT, and F 1 + 2, and decreased PAI-1 Ag and activity in arterialblood; uPA and sc-uPA were unchanged. The tissue plasminogen activatorantigen was higher in coronary sinus than arterial blood after 1 (39 +/- 5vs 24 +/- 4 ng/ml, P < 0.003), 4 (P < 0.003), and 10 min (P <0.004) reperfusion. Tissue plasminogen activator activity and t-PA/PAIcomplex increased, PAI-1 activity decreased, while all other parameterswere unchanged across the coronary circulation. In conclusion, CPB inducesfibrinolysis and coagulation. Cold cardioplegia induces t-PA release in thecoronary circulation, denoting a postischemic antithrombotic function ofthe coronary endothelium. Tissue plasminogen activator may be used toevaluate endothelial stimulation or injury induced by CPB, or by differentregimens of myocardial protection.

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