Tissue factor and tissue factor pathway inhibitor levels during and after cardiopulmonary resuscitation

Disseminated intravascular coagulation frequently occurs after global ische mia and reperfusion due to cardiac arrest. The present study was performed to demonstrate the role of tissue factor for coagulation pathway activation , as well as to investigate the precise time course of tissue factor pathwa y inhibitor (TFPI) during and after cardiopulmonary resuscitation (CPR), Th irty-two of out-of-hospital cardiac arrest patients were classified into tw o groups, those who achieved return of spontaneous circulation (ROSC) (n=13 ) and those without ROSC (n=19), Ten normal healthy volunteers served as co ntrol subjects. Serial levels of tissue factor and TFPI were measured durin g and after cardiac arrest and CPR. In patients with ROSC, cardiac arrest a nd CPR led to persistent increases in the levels of tissue factor that peak ed 6 hours after arrival at the Emergency Department. Tissue factor levels in patients without ROSC also showed marked elevations compared to those of the control subjects. In both groups, the levels of TFPI were significantl y lower than those in the control subjects. However, we could not find diff erences in the levels of the two markers between the patients with ROSC and those without ROSC, In conclusion, we demonstrated persistent elevation of the tissue factor levels associated with low TFPI during and after CPR in patients with out-of-hospital cardiac arrest. These results indicate the ac tivation of the extrinsic coagulation pathway without adequate TFPI generat ion, which may contribute to thrombin activation and fibrin formation after whole-body ischemia and reperfusion, (C) 1999 Elsevier Science Ltd. All ri ghts reserved.