Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany.
Clinic of Dortmund gGmbH, Clinic for Heart Surgery, Dortmund, Germany.
J Cardiothorac Vasc Anesth. 2020 Oct;34(10):2664-2673. doi: 10.1053/j.jvca.2020.03.040. Epub 2020 May 5.
The present study aimed to determine whether underlying disease, performed surgery, and dose of tranexamic acid influence fibrinolysis measured with D-dimer levels.
Retrospective analysis.
Single institution (Department of Cardiac Surgery and Section of Clinical Hemostaseology at the Düsseldorf University Hospital).
The study comprised 3,152 adult patients undergoing elective cardiac surgery between February 2013 and October 2016.
Two doses of tranexamic acid during surgery were administered.
D-dimer levels were analyzed at the start of surgery and before protamine administration. D-dimer levels at the start of surgery were compared according to disease. Intraoperative D-dimer development was analyzed according to the type of surgery and within 2 cohorts with different tranexamic acid doses. Interindividual variability was pronounced for D-dimer levels at the start of surgery, with significant differences among patients with coronary artery disease, valve disease, and aortic disease and patients undergoing heart transplantation compared with patients receiving a left ventricular assist device (p < 0.01). Aortic dissection, endocarditis, and extracorporeal life support were associated with higher D-dimer levels (p ≤ 0.01). With tranexamic acid at a fixed dose, intraoperative D-dimer levels decreased in on-pump and off-pump coronary bypass surgery, valve surgery, and left ventricular assist device surgery (p ≤ 0.02), but levels increased in aortic surgery and heart transplantations (p < 0.01). A decrease or increase in D-dimer levels during surgery was influenced significantly by a higher or lower tranexamic acid dose (p ≤ 0.01).
D-dimer testing allows for the assessment of individual fibrinolytic activity in cardiac surgery, which is influenced by disease type, surgery type, and dose of tranexamic acid. The assessment of the fibrinolytic status may have the potential to facilitate dose-adjusted antifibrinolytic therapy in the future.
本研究旨在确定基础疾病、手术类型和氨甲环酸剂量是否会影响 D-二聚体水平测量的纤溶作用。
回顾性分析。
单机构（杜塞尔多夫大学医院心脏外科和临床止血科）。
本研究纳入了 2013 年 2 月至 2016 年 10 月期间接受择期心脏手术的 3152 例成年患者。
手术期间给予 2 种剂量的氨甲环酸。
在手术开始时和鱼精蛋白给药前分析 D-二聚体水平。根据疾病比较手术开始时 D-二聚体水平。根据手术类型和 2 个不同氨甲环酸剂量组分析术中 D-二聚体发展情况。手术开始时 D-二聚体水平个体间差异明显，与接受左心室辅助装置的患者相比，冠状动脉疾病、瓣膜疾病和主动脉疾病以及接受心脏移植的患者之间存在显著差异（p<0.01）。主动脉夹层、心内膜炎和体外生命支持与较高的 D-二聚体水平相关（p≤0.01）。在固定剂量的氨甲环酸作用下，体外循环和非体外循环冠状动脉旁路移植术、瓣膜手术和左心室辅助装置手术中术中 D-二聚体水平降低（p≤0.02），但主动脉手术和心脏移植中水平升高（p<0.01）。手术过程中 D-二聚体水平的降低或升高受到氨甲环酸剂量高低的显著影响（p≤0.01）。
D-二聚体检测可评估心脏手术中的个体纤溶活性，其受疾病类型、手术类型和氨甲环酸剂量的影响。纤溶状态的评估可能具有未来实现剂量调整抗纤溶治疗的潜力。
