Secretion of tissue plasminogen activator and plasminogen activator inhibitor 1 during cardiopulmonary bypass

被引:31
作者
Chandler, WL [1 ]
Velan, T [1 ]
机构
[1] Univ Washington, Dept Lab Med, Seattle, WA 98195 USA
关键词
cardiopulmonary bypass; tissue plasminogen activator; plasminogen activator inhibitor; computer modeling;
D O I
10.1016/j.thromres.2003.11.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Cardiopulmonary bypass (CPB) is associated with elevated tissue plasminogen activator (t-PA) levels during CPB and increased plasminogen activator inhibitor 1 (PAI-1) levels post-operatively. The goal of this study was to estimate the rate of t-PA and PAI-1 secretion in vivo, before, during and after CPB. Materials and methods: Estimated rates of t-PA and PAI-1 secretion were based on measured levels of active and total t-PA, and active and total PAI-1, obtained before, during and after CPB from nine males, combined with a computer model of each patient's vascular system that continuously accounted for secretion, clearance, hemodilution, blood loss and transfusion. Results and conclusions: At baseline, the average t-PA and PAI-1 secretion rates were 0.74 +/- 0.33 and 1.28 +/- 0.74 pmol/s, respectively. Within 5 min of CPB initiation, t-PA secretion increased six-fold to 4.41 +/- 2.58 pmol/s, while PAI-1 secretion was unchanged, resulting in a six-fold increase in active t-PA levels. t-PA secretion remained elevated throughout CPB and into the early post-operative period. Average PAI-1 secretion did not start to increase until the end of CPB. By 2 It after surgery, average PAI-1 secretion had increased 15-fold to 19.60 +/- 17.10 pmol/s, resulting in reduced levels of active t-PA even though t-PA secretion was still elevated. We conclude that CPB induces an immediate sustained increase in t-PA secretion followed by a delayed progressive increase in PAI-1 production. Variations in the level of active t-PA are a function of the relative rates of t-PA versus PAI-1 secretion at different times during and after surgery. (C) 2004 Elsevier Ltd. All rights reserved.
引用
收藏
页码:185 / 192
页数:8
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