The Effects of Platelet-Rich-Plasma on Post-Cardiopulmonary Bypass Fibrinolysis

Abstract

Postoperative hemorrhage associated with cardiac surgery continues to be a major source of significant patient morbidity. Cardiopulmonary bypass (CPB) induces a number of hemostatic alterations which include platelet defects and coagulation factor imbalances. In addition, the fibrinolytic system is stimulated by CPB, adversely affecting the stability of the fibrin network, leading to early clot dissolution. Various techniques for reducing post-CPB bleeding have been studied, and have included plasmapheresis and the collection of autologous platelet-rich-plasma (PRP). The present study examined the effects of autotransfusing PRP in cardiac surgery patients and the associated effects on fibrinolysis. Twenty-six patients were diagnosed with fibrinolysis by whole blood elastokinetic monitoring (thrombelastography- TEG). The diagnosis of fibrinolysis was determined from the post-CPB TEG profile when clot dissolution exceeded 50% of the developed clot 30 minutes following protamine administration. Thirteen patients had been treated with PRP and 13 had not (Control- CTR). There were no differences seen in preoperative or operative parameters between the two groups, nor were there differences in routine laboratory coagulation tests. Total platelet yeild in the PRP group was 1.2 ± 0.6 X 1011. Patients in the CTR group had a total blood exposure of 39.4 ± 43.4 units compared to 8.6 ± 11.2 in the PRP patients (p<.02). This study supports the finding that CPB induces a fibrinolytic state, causing significant postoperative hemorrhage, which can be partially ameliorated by the infusion of autologous platelet-rich-plasma.