[Short-lasting infusions of Fibraccel following aortocoronary bypass surgery. The effect on postoperative blood loss and hemostasis depending on the time of extracorporeal circulation].

Bleeding is a major problem in the post-operative period (p.o.) after aortocoronary bypass surgery. Harke et al. have investigated the beneficial effect of homologous phospholipid complex (Fibraccel) after mitral and/or aortic valve replacement. No actual data were available evaluating therapy with Fibraccel after aortocoronary bypass grafting. We were especially interested in the influence of Fibraccel on routine blood coagulation parameters: partial thromboplastin time (PTT), thrombin time (TT), prothrombin time = Quick fibrinogen, platelet count and activated clotting time, spontaneous platelet aggregation (alpha 2/Tr, platelet aggregation test II of Breddin), thrombelastography, blood loss from the chest drain, use of fresh frozen plasma, and side-effects of the substance after aortocoronary bypass grafting. Forty patients (6 female, 35 male, mean age 58 years, ASA III-IV) were studied in a randomized order. Patients who had acetylsalicylic acid (ASS) or anticoagulants during the last 7 days before operation were excluded. In 20 patients 50-ml Fibraccel infusions lasting 30 min each were started immediately after antagonism by protamine chloride. Subsequent 50-ml Fibraccel infusions were given every 4 h until 20 h after extracorporeal circulation (ECC). The other 20 patients received placebo infusions at corresponding times. Each patient had a routine ASS medication (0.5 gi.v) about 8 h p.o. Blood samples for immediate analysis were taken: I = before operation; II = after ECC, before protamine; III = 90 min after protamine; IV = on the first p.o. day (20.5 h after protamine).(ABSTRACT TRUNCATED AT 250 WORDS)