CENTRIFUGAL AND ROLLER-PUMPS - ARE THERE DIFFERENCES IN COAGULATION AND FIBRINOLYSIS DURING AND AFTER CARDIOPULMONARY BYPASS

A number of hemostatic parameters reflecting the activation of coagula tion and fibrinolysis were investigated in a prospective study of 24 p atients undergoing cardiopulmonary bypass (CPB) during heart surgery. The patients were randomized to a group in which either a roller (grou p 1) or a centrifugal pump (group 2) was used. Blood samples were take n pre-operatively, at the onset of and every 20 min during CPB, after the administration of protamine, and 4, 20, 44, and 68 h postoperative ly. The groups did not differ significantly in hematocrit, fibrinogen, factor XIII, and antithrombin III. Significant differences in favor o f group 2 during and after CPB were found in prothrombin fragment F1+2 , plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TA T), and D-dimer (F1+2 P < 0.01 after 80-min CPB, PAP P < 0.005 after 4 0-min CPB, TAT and D-dimer P < 0.05 after 100-min CPB, D-dimer and PAP P < 0.05 after protamine administration, TAT and F1+2 4h after CPB). These findings indicate the activation of fibrinolysis preceding throm bin generation during cardiopulmonary bypass. In addition, we conclude that centrifugal blood pumping is beneficial in avoiding excessive ac tivation of both coagulation and fibrinolysis.