• Veronica Besser, Alexander Albert, Stephan Urs Sixt, Stefanie Ackerstaff, Elisabeth Roussel, Sebastian Ullrich, Artur Lichtenberg, and Till Hoffmann.
• Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany. Electronic address: veronica.besser@uni-duesseldorf.de.
• J. Cardiothorac. Vasc. Anesth. 2020 Oct 1; 34 (10): 2664-2673.

ObjectiveThe present study aimed to determine whether underlying disease, performed surgery, and dose of tranexamic acid influence fibrinolysis measured with D-dimer levels.DesignRetrospective analysis.SettingSingle institution (Department of Cardiac Surgery and Section of Clinical Hemostaseology at the Düsseldorf University Hospital).ParticipantsThe study comprised 3,152 adult patients undergoing elective cardiac surgery between February 2013 and October 2016.InterventionsTwo doses of tranexamic acid during surgery were administered.Measurements And Main ResultsD-dimer levels were analyzed at the start of surgery and before protamine administration. D-dimer levels at the start of surgery were compared according to disease. Intraoperative D-dimer development was analyzed according to the type of surgery and within 2 cohorts with different tranexamic acid doses. Interindividual variability was pronounced for D-dimer levels at the start of surgery, with significant differences among patients with coronary artery disease, valve disease, and aortic disease and patients undergoing heart transplantation compared with patients receiving a left ventricular assist device (p < 0.01). Aortic dissection, endocarditis, and extracorporeal life support were associated with higher D-dimer levels (p ≤ 0.01). With tranexamic acid at a fixed dose, intraoperative D-dimer levels decreased in on-pump and off-pump coronary bypass surgery, valve surgery, and left ventricular assist device surgery (p ≤ 0.02), but levels increased in aortic surgery and heart transplantations (p < 0.01). A decrease or increase in D-dimer levels during surgery was influenced significantly by a higher or lower tranexamic acid dose (p ≤ 0.01).ConclusionsD-dimer testing allows for the assessment of individual fibrinolytic activity in cardiac surgery, which is influenced by disease type, surgery type, and dose of tranexamic acid. The assessment of the fibrinolytic status may have the potential to facilitate dose-adjusted antifibrinolytic therapy in the future.Copyright © 2020 Elsevier Inc. All rights reserved.

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