Studies of fibrinolytic and coagulation factors during open heart surgery. II. Postoperative bleeding tendency and changes in the coagulation system.

In 9 patients with and without signs of preoperative increased turnover of coagulation factors were examined during and after open heart surgery by ECC the following coagulation parameters: thrombelastogram, partial thromboplastin time, thrombin time, platelets, antithrombin-III-activity and the separate plasmic coagulation factors (II, V, VII, VIII, IX, X). During ECC a qualitatively similar coagulation disturbance developed in all patients, but it was more marked in patients with postoperative bleeding complications. This coagulation disturbance may be called an increased turnover of coagulation factors with reactive fibrinolysis and may be seen as the cause of the postoperative hemorrhagic diathesis. Therefore neutralization of heparin with protamine chloride at the end of ECC is contraindicated.