Objective: Although it is suggested that modified ultrafiltration appears to have a hemostatic function, the effects of modified ultrafiltration on the coagulation and fibrinolysis system is unknown. We have investigated the effect of modified ultrafiltration on the coagulation and fibrinolysis system in pediatric cardiac surgery.
Methods: Ten consecutive patients (23.7±23.6 month old, 9.3±5.5 kg) who underwent cardiac surgery with modified ultrafiltration were investigated. We measured hematocrit, platelet count, coagulation factors (fibrinogen, factor V, VII, X, and XIII), and fibrinolytic factors (alpha 2 plasmin inhibitor and plasmin-alpha 2 plasmin inhibitor complex) before and after modified ultrafiltration.
Results: Hematocrit and platelet count were increased after modified ultrafiltration (hematocrit; 27.5±6.7 → 40.8±6.1 %, platelet count; 9.7±3.6 → 14.2±3.6×10⁴ /μl, p<0.05). Additionally, fibrinogen (78.8±12.5 → 95.3±14.8 mg/dl), factor V (25.1±7.0 → 37.3±13.1 %), VII (23.3±8.1 → 44.3±19.9 %), X (24.2±6.5 → 33.0±8.8 %), and XIII (30.9±9.9 → 40.7±7.6 %) levels were increased after modified ultrafiltration (p<0.05). Although plasmin-alpha2 plasmin inhibitor complex was same level during modified ultrafiltration (24.6±47.5 → 28.0±53.1 μg/ml, p=0.9), alpha2 plasmin inhibitor was increased after modified ultrafiltration (42.8±8.7 → 52.9±8.2 %, p<0.05), that means fibrinolysis system was not activated during modified ultrafiltration.
Conclusion: Coagulation factor levels were increased same as hemoconcentration, and fibrinolysis system was not activated during modified ultrafiltration. It suggests modified ultrafiltration have an intraoperative hemostatic effect in pediatric cardiac surgery.