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Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass.
Anesth Analg. 2004 Sep; 99(3):634-40, table of contents.A&A

Abstract

Activation of coagulation, fibrinolysis, and the vascular endothelium occurs after heart surgery with cardiopulmonary bypass (CPB), but the effects of eliminating CPB in patients undergoing coronary artery bypass grafting (CABG) are unknown. Therefore, we compared the hemostatic profiles of off-pump and on-pump CABG patients. Two groups of consecutive patients participating in a larger trial (the Octopus Trial) were randomly allocated to undergo CABG with (n = 20) or without (n = 20) CPB. Platelet numbers and plasma concentrations of P-selectin, prothrombin fragment 1.2 (F1.2), soluble fibrin, d-dimers, and von Willebrand factor (as a marker of endothelial cell activation) were measured and corrected for hemodilution. Compared with the on-pump CABG group, F1.2 and d-dimer levels were significantly lower (P = 0.004 and P = 0.03, respectively) in patients having CABG surgery performed off-pump. In the CPB group, F1.2 (median [interquartile range], 450% of baseline [233%-847%]) and d-dimer (538% [318%-1192%]) peaked in the immediate postoperative period and remained increased until Day 4, whereas in the off-pump group, F1.2 and d-dimer levels increased more gradually and peaked on Day 4 (342% [248%-515%] and 555% [387%-882%], respectively). In both groups, von Willebrand factor concentrations were increased until Day 4 (CPB, 308% [228%-405%]; off-pump, 288% [167%-334%]). Despite heparinization, CABG surgery with CPB was associated with excessive thrombin generation and fibrinolytic activity immediately after surgery. The off-pump group demonstrated a delayed postoperative response that became equal in magnitude to the CPB in the later (20-96 h) postoperative period.

Authors+Show Affiliations

Department of Hematology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15333385

Citation

Lo, Bernard, et al. "Activation of Hemostasis After Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass." Anesthesia and Analgesia, vol. 99, no. 3, 2004, 634-40, table of contents.
Lo B, Fijnheer R, Castigliego D, et al. Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass. Anesth Analg. 2004;99(3):634-40, table of contents.
Lo, B., Fijnheer, R., Castigliego, D., Borst, C., Kalkman, C. J., & Nierich, A. P. (2004). Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass. Anesthesia and Analgesia, 99(3), 634-40, table of contents.
Lo B, et al. Activation of Hemostasis After Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass. Anesth Analg. 2004;99(3):634-40, table of contents. PubMed PMID: 15333385.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass. AU - Lo,Bernard, AU - Fijnheer,Rob, AU - Castigliego,Domenico, AU - Borst,Cornelius, AU - Kalkman,Cor J, AU - Nierich,Arno P, PY - 2004/8/31/pubmed PY - 2004/9/24/medline PY - 2004/8/31/entrez SP - 634-40, table of contents JF - Anesthesia and analgesia JO - Anesth Analg VL - 99 IS - 3 N2 - Activation of coagulation, fibrinolysis, and the vascular endothelium occurs after heart surgery with cardiopulmonary bypass (CPB), but the effects of eliminating CPB in patients undergoing coronary artery bypass grafting (CABG) are unknown. Therefore, we compared the hemostatic profiles of off-pump and on-pump CABG patients. Two groups of consecutive patients participating in a larger trial (the Octopus Trial) were randomly allocated to undergo CABG with (n = 20) or without (n = 20) CPB. Platelet numbers and plasma concentrations of P-selectin, prothrombin fragment 1.2 (F1.2), soluble fibrin, d-dimers, and von Willebrand factor (as a marker of endothelial cell activation) were measured and corrected for hemodilution. Compared with the on-pump CABG group, F1.2 and d-dimer levels were significantly lower (P = 0.004 and P = 0.03, respectively) in patients having CABG surgery performed off-pump. In the CPB group, F1.2 (median [interquartile range], 450% of baseline [233%-847%]) and d-dimer (538% [318%-1192%]) peaked in the immediate postoperative period and remained increased until Day 4, whereas in the off-pump group, F1.2 and d-dimer levels increased more gradually and peaked on Day 4 (342% [248%-515%] and 555% [387%-882%], respectively). In both groups, von Willebrand factor concentrations were increased until Day 4 (CPB, 308% [228%-405%]; off-pump, 288% [167%-334%]). Despite heparinization, CABG surgery with CPB was associated with excessive thrombin generation and fibrinolytic activity immediately after surgery. The off-pump group demonstrated a delayed postoperative response that became equal in magnitude to the CPB in the later (20-96 h) postoperative period. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/15333385/Activation_of_hemostasis_after_coronary_artery_bypass_grafting_with_or_without_cardiopulmonary_bypass_ L2 - https://doi.org/10.1213/01.ANE.0000130257.64006.5C DB - PRIME DP - Unbound Medicine ER -