Krvácení po kardiochirurgických výkonech. Význam fibrinolýzy a možnosti jejího ovlivnění u operací s mimotělním oběhem a bez mimotělního oběhu

• Main Author: Jareš, Martin
• Other Authors: Vaněk, Tomáš
• Format: Doctoral Thesis
• Language: Czech
• Published: 2009
• Online Access: http://www.nusl.cz/ntk/nusl-278674

The aim of our two prospective randomized studies was to evaluate and compare haemostatic effects of fibrinolytic inhibitors in patients undergoing off-pump coronary artery bypass surgery (OPCAB). The first study evaluated efficacy of tranexamic acid vs. placebo, the second one compared effects of tranexamic acid vs. aprotinin vs. placebo. In addition, the risk of per operative myocardial ischemia and trombotic events was assessed. In the first study postoperative bleeding was significantly lower in the tranexamic acid group compared with the control group. We observed two postoperative myocardial infarctions (one in each group) and any cerebrovacular event or pulmonary embolism. In the second study we conclude that both tranexamic acid and aprotinin significantly reduce the postoperative blood loss in OPCAB patients, and the efficacy of tranexamic acid and aprotinin, respectively, seems to be quite similar. We did not observe any statistically significant difference in the need for allogenic transfusion, although the total number of re-transfused patients was the highest in placebo group. Treated groups did not demonstrate postoperative increase in mean levels of myocardial enzymes, compared with placebo group. Significantly higher mean values of D-dimer were found in placebo group 24 h...