Effects Of Anti-fibrinolytic Drugs On Coagulation And Fibrinolysis In Patients Undergoing Thoracic Surgery

Objective To observe the perioperative changes of coagulation and fibrinolysis in the thoracic surgery ,and evaluate the effects of aprotinin, tranexamic acid and ethylenediamine diaceturate on coagulation and fibrinolysis in patients undergoing thoracotomy.Method Eighty ASA â…  â…¡ patients with lung cancer or esophageal carcinoma undergoing thoracic surgery were randomly divided into four groups: Group A receiving 1 × 10⁶ kallikrein inhibitor units (KIU) of aprotinin as a bolus before skin incision and 2.5 × 10⁵ KIU/h during surgery, Group T receiving 10 mg/kg tranexamic acid as a bolus before skin inciscion and 1 mg ·kg^-1 ·h^-1 during surgery, Group E receiving 0.6 mg ethylenediamine diaceturate before skin incision, And Group C receiving isotonic saline infusion instead (n=20 in each group). The central venous blood samples were taken from all the patients before operation, at 3 hours after the beginningof operation, on the 1st and 3rd days after operation, respectively. The prothrombin time (PT), actived partial thromboplastin time (APTT), thrombin time (TT), fibriongrn (Fib) concentration, tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor-1 (PAI-1) activity, D-dimer concentration, antithrombin-â…¢(AT-â…¢), blood platelet count, thromboelastography (TEG) were monitored. The volume of introperative blood loss and chest tube drainge at 24 hours posteoperatively were recorded.Results (1) There was a decrease in reaction (R) and coagulation (K) time during and after operation in all the four groups, but the difference had no statistical significance. There was an increase in maximum amplitude (MA) during operation and on the first day after operation in Groups T, E and C and it recovered to the preoperative level on the third day after operation. MA had no difference at each time point in Group A. There was a significant decrease in clotting index (CI) during and after operation in Groups C and T (P<0.01 and P<0.05), but there was no significant difference at each time point in Group A (P>0.05). However, there was a significant increase in CI during and after operation inGroup E. CI were significantly higher in Groups A, T and E than in Group C (PO.01, PO.05 and P<0.01). LY30 increased after operation in all the four groups, and the difference had statistical significance in Group C (P<0.01). LY30 were significantly lower in Groups A, T and E than in Group C. (2) The blood platelet counts decreased during operation and on the 1st day after operation and recoverd to the preoperative level on the 3rd day after operation in Groups T, E and C ,except Group E, the difference had no statistical significance (P<0.05). The blood platelet count did not change in Group A. (3) In Groups A, T and E, there was no significant alteration in PT, APTT, and in Group C, PT and APTT increased during and after operation compared with that before operation, but the difference did not reach statistical significance. Fib concentrations decreased during and after operation in all the groups, and the difference did not reach statistical significance in Groups A, T and E, whereas there was a significant decrease in Group C (PO.05). (4) Intraoperative t-PA activities were significantly lower in Groups A, T and E than in Group C (P<0.01).intraoperative PAI activities had no significant difference compared with preoperative ones in all the four groups, but postoperative PAI activities increased significantly compared with preoperative ones (P<0.01). Postoperative PAI activities were higher in Groups A, T and E than in Group C, but the difference did not reach statistical significance (P>0.05). (5) In Groups A, T and E, intraoperative D-Dimer concentrations had no signicant difference compared with preoperative ones (P>0.05), but postoperative D-Dimer concentrations increased significantly compared with preoperative ones. In Group C, intro- and post-operative D-Dimer concentrations increased significantly compared with preoperative ones (PO.05). D-Dimer concentrations reached peak on 1st day after operation in all the four groups. Intra- and post-operative D-Dimer concentrations in Groups A and T and postoperative D-Dimer concentrations in Group E were significantly lower than those in Group C (PO.05). (6) In all the four groups , intra- and post-operative AT-III concentrations decreased significantly compared with preoperative ones and they reached the lowest point on the first day after operation. Intra- and post-operative AT-III concentrations were significantly higher in Group A than in Groups T, E and C. (7) The volume of intraoperative blood loss and chest tube drainage at 24 hours postoperatively in Groups A, T and E was significantly lower than that in Group C (PO.01).Conclusions (1) The main reason of bleeding during thoracic surgury is the increaseof fibrinolysis activity and the deficiency of coagulation factors. (2) Aprotinin, tranexamic acid and ethylenediamine diaceturate can decrease the perioperative blood loss . The effects of aprotinin, tranexamic acid and ethylenediamine diaceturate on coagulation and fibrinolysis function are different. Aprotinin can stabilize the perioperative coagulability, however, ethylenediamine diaceturate may lead to hypercoagulability.