Background: Carriers of plasminogen activator inhibitor -1 (PAI-1) -675 genotype 5G/5G may be associated with\nlower preoperative PAI-1 plasma levels and higher blood loss after heart surgery using cardiopulmonary bypass\n(CPB). We speculate if polymorphisms of PAI-1 -844 A/G and angiotensin converting enzyme (ACE) intron 16 I/D also\nmight promote fibrinolysis and increase postoperative bleeding.\nMethods: We assessed PAI-1 -844 A/G, and ACE intron 16 I/D polymorphisms by polymerase chain reaction\ntechnique and direct sequencing of genomic DNA from 83 open heart surgery patients that we have presented\nearlier. As primary outcome, accumulated chest tube drainage (CTD) at 4 and 24 h were analyzed for association\nwith genetic polymorphisms. As secondary outcome, differences in plasma levels of PAI-1, t-PA/PAI-1 complex and\nD-dimer were determined for each polymorphism. SPSS�® was used for statistical evaluation.\nResults: The lowest preoperative PAI-1 plasma levels were associated with PAI-1 -844 genotype G/G, and\nhigher CTD, as compared with genotype A/A at 4 and 24 h after surgery. Correspondingly, 4 h after the\nsurgery CTD was higher in carriers of ACE intron 16 genotype I/I, as compared with genotype D/D. PAI-1\nplasma levels and t-PA/PAI-1 complex reached nadir in carriers of ACE intron 16 genotype I/I, in whom we\nalso noticed the highest D-dimer levels immediately after surgery. Notably, carriers of PAI-1 -844 genotype\nG/G displayed higher D-dimer levels at 24 h after surgery as compared with those of genotype A/G.\nConclusions: Increased postoperative blood loss secondary to enhanced fibrinolysis was associated with\ncarriers of PAI-1 -844 G/G and ACE Intron 16 I/I, suggesting that these genotypes might predict increased\npostoperative blood loss after cardiac surgery using CPB.
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