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Quantitative and temporal differences in coagulation, fibrinolysis and platelet activation after on-pump and off-pump coronary artery bypass surgery.
Heart Lung Circ. 2009 Apr; 18(2):123-30.HL

Abstract

BACKGROUND

With the increasing use of OPCAB, potentially devastating thromboembolic events, including graft thrombosis may become increasingly evident. We present a study of the quantitative and temporal differences of the coagulation system, fibrinolysis and platelet activation after coronary artery surgery with or without cardiopulmonary bypass.

METHODS

Patients undergoing on-pump CABG (n=10) or OPCAB (n=10) had six blood samples taken before surgery and up to 24h post-operatively. Activation of the coagulation cascade (tissue factor pathway-factor VIIa), endothelial injury (von Willebrand Factor antigen), thrombin generation (prothrombin fragments FI+II), fibrinolysis (decreased plasminogen levels), fibrin degradation (D-Dimer), platelet counts and platelet activation (soluble P-selectin) were quantified.

RESULTS

CABG caused earlier and more significant generation of thrombin, however OPCAB caused a late and sustained generation of thrombin. CABG caused intraoperative activation of fibrinolysis and fibrin degradation, however, at 24h these parameters were equally elevated in both groups. Platelet activation was significant in the CABG group, but did not occur in the OPCAB group.

CONCLUSIONS

Late thrombin generation and reduced fibrinolysis in the presence of intact, functioning platelets may contribute to adverse thromboembolic events after OPCAB surgery. Thromboembolic prophylaxis and anti-platelet therapy may need to be more aggressive after OPCAB surgery.

Authors+Show Affiliations

The Baird Institute, 304/100 Carillon Avenue, Newtown, Sydney, NSW 2042, Australia. michael.vallely@bigpond.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19081297

Citation

Vallely, Michael P., et al. "Quantitative and Temporal Differences in Coagulation, Fibrinolysis and Platelet Activation After On-pump and Off-pump Coronary Artery Bypass Surgery." Heart, Lung & Circulation, vol. 18, no. 2, 2009, pp. 123-30.
Vallely MP, Bannon PG, Bayfield MS, et al. Quantitative and temporal differences in coagulation, fibrinolysis and platelet activation after on-pump and off-pump coronary artery bypass surgery. Heart Lung Circ. 2009;18(2):123-30.
Vallely, M. P., Bannon, P. G., Bayfield, M. S., Hughes, C. F., & Kritharides, L. (2009). Quantitative and temporal differences in coagulation, fibrinolysis and platelet activation after on-pump and off-pump coronary artery bypass surgery. Heart, Lung & Circulation, 18(2), 123-30. https://doi.org/10.1016/j.hlc.2008.08.012
Vallely MP, et al. Quantitative and Temporal Differences in Coagulation, Fibrinolysis and Platelet Activation After On-pump and Off-pump Coronary Artery Bypass Surgery. Heart Lung Circ. 2009;18(2):123-30. PubMed PMID: 19081297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantitative and temporal differences in coagulation, fibrinolysis and platelet activation after on-pump and off-pump coronary artery bypass surgery. AU - Vallely,Michael P, AU - Bannon,Paul G, AU - Bayfield,Matthew S, AU - Hughes,Clifford F, AU - Kritharides,Len, Y1 - 2008/12/09/ PY - 2008/03/14/received PY - 2008/06/22/revised PY - 2008/08/28/accepted PY - 2008/12/17/entrez PY - 2008/12/17/pubmed PY - 2009/7/8/medline SP - 123 EP - 30 JF - Heart, lung & circulation JO - Heart Lung Circ VL - 18 IS - 2 N2 - BACKGROUND: With the increasing use of OPCAB, potentially devastating thromboembolic events, including graft thrombosis may become increasingly evident. We present a study of the quantitative and temporal differences of the coagulation system, fibrinolysis and platelet activation after coronary artery surgery with or without cardiopulmonary bypass. METHODS: Patients undergoing on-pump CABG (n=10) or OPCAB (n=10) had six blood samples taken before surgery and up to 24h post-operatively. Activation of the coagulation cascade (tissue factor pathway-factor VIIa), endothelial injury (von Willebrand Factor antigen), thrombin generation (prothrombin fragments FI+II), fibrinolysis (decreased plasminogen levels), fibrin degradation (D-Dimer), platelet counts and platelet activation (soluble P-selectin) were quantified. RESULTS: CABG caused earlier and more significant generation of thrombin, however OPCAB caused a late and sustained generation of thrombin. CABG caused intraoperative activation of fibrinolysis and fibrin degradation, however, at 24h these parameters were equally elevated in both groups. Platelet activation was significant in the CABG group, but did not occur in the OPCAB group. CONCLUSIONS: Late thrombin generation and reduced fibrinolysis in the presence of intact, functioning platelets may contribute to adverse thromboembolic events after OPCAB surgery. Thromboembolic prophylaxis and anti-platelet therapy may need to be more aggressive after OPCAB surgery. SN - 1444-2892 UR - https://www.unboundmedicine.com/medline/citation/19081297/Quantitative_and_temporal_differences_in_coagulation_fibrinolysis_and_platelet_activation_after_on_pump_and_off_pump_coronary_artery_bypass_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1443-9506(08)00866-4 DB - PRIME DP - Unbound Medicine ER -