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Prepublished online as a Blood First Edition Paper on December 12, 2002; DOI 10.1182/blood-2002-08-2400. This Article Full Text Full Text (PDF) Supplemental PDF All Versions of this Article: 2002-08-2400v1 101/11/4355    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Chandler, W. L. Articles by Velan, T. Search for Related Content PubMed PubMed Citation Articles by Chandler, W. L. Articles by Velan, T. Related Collections Hemostasis, Thrombosis, and Vascular Biology Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 June 2003, Vol. 101, No. 11, pp. 4355-4362 HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY Estimating the rate of thrombin and fibrin generation in vivo during cardiopulmonary bypass Wayne L. Chandler, and Tomas Velan From the Department of Laboratory Medicine, University of Washington, Seattle, WA. Our objective was to estimate the in vivo rates of thrombin and fibrin generation to better understand how coagulation is regulated. Studied were 9 males undergoing cardiopulmonary bypass (CPB). The rates of thrombin, total fibrin, and soluble fibrin generation in vivo were based on measured levels of prothrombin activation peptide F1.2, thrombin-antithrombin complex, fibrinopeptide A, and soluble fibrin, combined with a computer model of the patient's vascular system that accounted for marker clearance, hemodilution, blood loss, and transfusion. Prior to surgery, the average thrombin generation rate was 0.24 ± 0.11 pmol/s. Each thrombin molecule in turn generated about 100 fibrin molecules, of which 1% was soluble fibrin. The thrombin generation rate did not change after sternotomy or administration of heparin, then rapidly increased 20-fold to 5.60 ± 6.65 pmol/s after 5 minutes of CPB (P = .000 05). Early in CPB each new thrombin generated only 4 fibrin molecules, of which 35% was soluble fibrin. The thrombin generation rate was 2.14 ± 1.88 pmol/s during the remainder of CPB, increasing again to 5.47 ± 4.08 pmol/s after reperfusion of the ischemic heart (P = .000 08). After heparin neutralization with protamine, thrombin generation remained high (5.34 ± 4.01 pmol/s, P = .0002) and total fibrin generation increased, while soluble fibrin generation decreased. By 2 hours after surgery, thrombin and fibrin generation rates were returning to baseline levels. We conclude that cardiopulmonary bypass and reperfusion of the ischemic heart results in bursts of nonhemostatic thrombin generation and dysregulated fibrin formation, not just a steady increase in thrombin generation as suggested by previous studies. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: P. Raivio, J. Petaja, A. Kuitunen, and R. Lassila Thrombophilic Variables Do Not Increase the Generation or Procoagulant Activity of Thrombin During Cardiopulmonary Bypass Ann. Thorac. Surg., February 1, 2008; 85(2): 536 - 542. [Abstract] [Full Text] [PDF] R. Taneja and D. C. Cheng Con: Heparin-Bonded Cardiopulmonary Bypass Circuits Should Be Routine for All Cardiac Surgical Procedures Anesth. Analg., December 1, 2006; 103(6): 1370 - 1372. [Full Text] [PDF] R. Ponce, K. Armstrong, K. Andrews, J. Hensler, K. Waggie, J. Heffernan, T. Reynolds, and M. Rogge Safety of Recombinant Human Factor XIII in a Cynomolgus Monkey Model of Extracorporeal Blood Circulation Toxicol Pathol, October 1, 2005; 33(6): 702 - 710. [Abstract] [Full Text] [PDF] B. Dixon, J. Santamaria, and D. Campbell Coagulation Activation and Organ Dysfunction Following Cardiac Surgery Chest, July 1, 2005; 128(1): 229 - 236. [Abstract] [Full Text] [PDF]

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