Anti-fibrinolytic therapy in thoracic aortic surgery

Abstract

Background. Bleeding is an important cause of morbidity in thoracic aortic surgery. Methods. We reviewed the mechanisms for fibrinolysis in aortic surgery and the propensity for intervention. Several studies have addressed the safety and efficacy of aprotinin. Results. The endothelium regulates the balance between thrombosis and fibrinolysis. During hypothermic circulatory arrest, thrombin generation stimulates protein C production and tissue plasminogen activator release to promote fibrinolysis. Hypothermia also adversely affects platelet function and coagulation. Controversy exists regarding the effectiveness and dangers of antifibrinolytic agents after circulatory arrest. Conclusions. Fibrinolysis remains problematic during thoracic aortic aneurysm surgery. Heparin management is complicated by aprotinin and insufficient heparin may result in thrombotic events. Aprotinin is safe during rewarming or postoperatively.