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Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study.
Ann Thorac Surg. 2005 Aug; 80(2):586-93.AT

Abstract

BACKGROUND

We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery.

METHODS

Thirty-one patients were randomized to on-pump or off-pump coronary artery bypass grafting. Factors of hemostasis as well as markers of endothelial activation were measured up to 24 hours after the operation: Fibrin D dimer, prothrombin fragment 1+2, alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor. Overall hemostasis potential, overall coagulation potential, and overall fibrinolysis potential were determined with a previously developed assay. We also measured platelet count before and after surgery.

RESULTS

Fibrin D dimer and prothrombin fragment 1+2 concentrations were lower during surgery in the off-pump group (p < 0.001). Four hours after admission to the intensive care unit, these differences were eliminated. alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor concentrations did not differ between groups (p = 0.59, p = 0.28, p = 0.22, and p = 0.69). Protein C1 esterase inhibitor and von Willebrand factor concentrations increased over time (p < 0.001) in both groups. Overall hemostasis potential and overall coagulation potential increased over time (p < 0.001), while overall fibrinolysis potential decreased (p < 0.001) with no difference between groups (p = 0.69, p = 0.91). Platelet count decreased on the first postoperative day (p < 0.001), but increased from the first to the third postoperative day (p = 0.004) in both groups without any inter group difference (p = 0.82).

CONCLUSIONS

There was a tendency toward less activation of coagulation and fibrinolysis in low-risk patients during elective off-pump coronary artery bypass surgery when compared with on-pump surgery.

Authors+Show Affiliations

Department of Cardiothoracic Surgery and Anesthesia, Karolinska University Hospital, Stockholm, Sweden. jenny.vedin@karolinska.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16039210

Citation

Vedin, Jenny, et al. "Hemostasis in Off-pump Compared to On-pump Coronary Artery Bypass Grafting: a Prospective, Randomized Study." The Annals of Thoracic Surgery, vol. 80, no. 2, 2005, pp. 586-93.
Vedin J, Antovic A, Ericsson A, et al. Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study. Ann Thorac Surg. 2005;80(2):586-93.
Vedin, J., Antovic, A., Ericsson, A., & Vaage, J. (2005). Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study. The Annals of Thoracic Surgery, 80(2), 586-93.
Vedin J, et al. Hemostasis in Off-pump Compared to On-pump Coronary Artery Bypass Grafting: a Prospective, Randomized Study. Ann Thorac Surg. 2005;80(2):586-93. PubMed PMID: 16039210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study. AU - Vedin,Jenny, AU - Antovic,Aleksandra, AU - Ericsson,Anders, AU - Vaage,Jarle, PY - 2004/10/05/received PY - 2005/01/28/revised PY - 2005/02/03/accepted PY - 2005/7/26/pubmed PY - 2006/9/6/medline PY - 2005/7/26/entrez SP - 586 EP - 93 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 80 IS - 2 N2 - BACKGROUND: We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery. METHODS: Thirty-one patients were randomized to on-pump or off-pump coronary artery bypass grafting. Factors of hemostasis as well as markers of endothelial activation were measured up to 24 hours after the operation: Fibrin D dimer, prothrombin fragment 1+2, alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor. Overall hemostasis potential, overall coagulation potential, and overall fibrinolysis potential were determined with a previously developed assay. We also measured platelet count before and after surgery. RESULTS: Fibrin D dimer and prothrombin fragment 1+2 concentrations were lower during surgery in the off-pump group (p < 0.001). Four hours after admission to the intensive care unit, these differences were eliminated. alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor concentrations did not differ between groups (p = 0.59, p = 0.28, p = 0.22, and p = 0.69). Protein C1 esterase inhibitor and von Willebrand factor concentrations increased over time (p < 0.001) in both groups. Overall hemostasis potential and overall coagulation potential increased over time (p < 0.001), while overall fibrinolysis potential decreased (p < 0.001) with no difference between groups (p = 0.69, p = 0.91). Platelet count decreased on the first postoperative day (p < 0.001), but increased from the first to the third postoperative day (p = 0.004) in both groups without any inter group difference (p = 0.82). CONCLUSIONS: There was a tendency toward less activation of coagulation and fibrinolysis in low-risk patients during elective off-pump coronary artery bypass surgery when compared with on-pump surgery. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16039210/Hemostasis_in_off_pump_compared_to_on_pump_coronary_artery_bypass_grafting:_a_prospective_randomized_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(05)00304-8 DB - PRIME DP - Unbound Medicine ER -