Mustafa TOK, Engin SAGDİLEK, Betül ÇAM, Kasım ÖZLÜK

Kardiyopulmoner Bypass’ın Trombosit Agregasyonu ve Fibrinoliz Üzerine Etkileri

Bu çalışmada, off-pump ve on-pump koroner bypass uygulanan hastalarda, prokoagülan aktivitede önemli rolü olan trombositlerin aktivite düzeyleri ve fibrinolitik aktivite değerlendirilmiştir. Çalışma, prospektif olarak planlanıp koroner bypass yapılan hastalar pompasız hasta grubunda 11 hasta, pompalı hasta grubunda 11 hasta olmak üzere, toplam 22 hasta değerlendirmeye alındı. Hastalardan ameliyat öncesi, ameliyat sonrası 1. saat, 1. gün ve 4. günde kan örnekleri alındı. Fibrinolitik aktiviteyi belirlemek için t-PA, u-PA, PAI-1, t-PA/PAI-1 ve D-Dimer, trombosit aktivitesini belirlemek için trombosit agregasyonu ölçüldü. On-pump grubunda daha fazla olmak üzere her iki grupta da ameliyat sonrasında fibrinolitik aktivite yüksek bulundu. Bu değerler ameliyat sonrası 4. günde ameliyat öncesi seviyelerine döndü. Trombosit agregasyonu her iki grupta da anlamlı bir fark göstermedi. Genellikle on-pump ameliyatlarda hemodilüsyon ve kullanılan yüksek doz heparin nedeni ile ameliyat sonrası erken tromboz riskinin düşük olduğu düşünülür. Buna bağlı olarak da erken dönem antikoagulan kullanımı yaygın değildir. Buna karşılık off-pump bypass ameliyatlarında erken dönemde antikoagulan kullanma alışkanlığı vardır. Yaptığımız bu çalışmanın gösterdiği sonuç kardiyopulmoner bypass kullanılan hastalarda ameliyat sonrası D-dimer yüksekliği erken tromboz riskinin pompa sonrası da devam ettiğini göstermektedir ve hemen ameliyat sonrası antikoagulan kullanımı düşünülebilir.

Anahtar Kelimeler:

Off-pump, bypass, trombosit agregasyonu, fibrinoliz, açık kalp ameliyatı.

The Effects of Cardiopulmonary Bypass on Platelet Aggregation and Fibrinolysis

In this study, platelet activity and fibrinolysis, which have an important role in hemostasis, were evaluated in patients undergoing off-pump and on-pump coronary bypass operation. Study was planned prospectively and a total of 22 patients who underwent coronary bypass operation were divided in two groups. 11 patients in off-pump group and 11 patients in the on-pump group were evaluated. Blood samples were taken from the patients preoperatively, 1 hour, 1 day and 4 days after surgery. t-PA, u-PA, PAI-1, t-PA/PAI-1 and D-Dimer were used to determine fibrinolytic activity, and platelet aggregation was measured to determine the degree of platelet activity. Postoperative fibrinolytic activity was higher in both groups, especially in on-pump group. Postoperative levels return to preoperative levels on the 4th day. There was no significant difference in the activity levels of platelets in both groups. It is generally considered that the risk of early postoperative thrombosis is low due to hemodilution and high-dose heparin used in on-pump surgeries. Accordingly, the use of early anticoagulants is not common. On the other hand, there is a habit of using anticoagulants in the early period in off-pump bypass surgeries. The results of our study show that the post-operative D-dimer elevation in patients using cardiopulmonary bypass shows that the risk of early thrombosis continues after the pump and, the use of anticoagulants immediately after surgery can be considered.

Keywords:

Off-pump, bypass, platelet aggregation, fibrinolysis, open heart surgery.,

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