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Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study.
Coron Artery Dis. 2009 Mar; 20(2):100-5.CA

Abstract

OBJECTIVE

To delineate the effects of extracorporeal bypass on biomarkers of hemostasis, fibrinolysis, and inflammation and clinical sequelae.

METHODS

Patients were assigned prospectively and randomly to either on-pump (n=41) or off-pump (n=51) coronary bypass surgery. The concentrations of C-reactive protein, fibrinogen, D-dimer, and plasminogen activator inhibitor type-1 in blood were quantified before and after (1 and 24 h) surgery. Similar surgical and anesthetic procedures were used for both groups. Clinical events were assessed during initial hospitalization and at the end of 1 year.

RESULTS

The concentrations of plasminogen activator inhibitor type-1 and D-dimer were greater compared with preoperative values 1 and 24 h after surgery in both groups, but their concentrations increased to a greater extent 24 h after surgery in the on-pump group (P<0.01). The concentration of C-reactive protein did not change appreciably immediately after surgery in either group but increased in a parallel manner 24 h after either on-pump or off-pump surgery (P<0.01). Bypass surgery in the on-pump group was associated with greater blood loss during surgery and more bleeding after surgery (P< or =0.01). The incidence of all other complications was similar in the two groups.

CONCLUSION

On-pump surgery was associated with biochemical evidence of a prothrombotic state early after surgery but no greater incidence of thrombotic events was observed. The prothrombotic state might be a consequence of extracorporeal bypass, compensation in response to more bleeding, or both in patients undergoing on-pump surgery.

Authors+Show Affiliations

Heart Institute, University of São Paulo, São Paulo, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

19293667

Citation

Paulitsch, Felipe S., et al. "Hemostatic Changes and Clinical Sequelae After On-pump Compared With Off-pump Coronary Artery Bypass Surgery: a Prospective Randomized Study." Coronary Artery Disease, vol. 20, no. 2, 2009, pp. 100-5.
Paulitsch FS, Schneider D, Sobel BE, et al. Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study. Coron Artery Dis. 2009;20(2):100-5.
Paulitsch, F. S., Schneider, D., Sobel, B. E., Rached, R., Ramires, J., Jatene, F., Stolf, N., Hueb, W., & Lopes, N. H. (2009). Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study. Coronary Artery Disease, 20(2), 100-5. https://doi.org/10.1097/MCA.0b013e3283219e8b
Paulitsch FS, et al. Hemostatic Changes and Clinical Sequelae After On-pump Compared With Off-pump Coronary Artery Bypass Surgery: a Prospective Randomized Study. Coron Artery Dis. 2009;20(2):100-5. PubMed PMID: 19293667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study. AU - Paulitsch,Felipe S, AU - Schneider,David, AU - Sobel,Burton E, AU - Rached,Roberto, AU - Ramires,José, AU - Jatene,Fabio, AU - Stolf,Noedir, AU - Hueb,Whady, AU - Lopes,Neuza H, PY - 2009/3/19/entrez PY - 2009/3/19/pubmed PY - 2009/6/6/medline SP - 100 EP - 5 JF - Coronary artery disease JO - Coron Artery Dis VL - 20 IS - 2 N2 - OBJECTIVE: To delineate the effects of extracorporeal bypass on biomarkers of hemostasis, fibrinolysis, and inflammation and clinical sequelae. METHODS: Patients were assigned prospectively and randomly to either on-pump (n=41) or off-pump (n=51) coronary bypass surgery. The concentrations of C-reactive protein, fibrinogen, D-dimer, and plasminogen activator inhibitor type-1 in blood were quantified before and after (1 and 24 h) surgery. Similar surgical and anesthetic procedures were used for both groups. Clinical events were assessed during initial hospitalization and at the end of 1 year. RESULTS: The concentrations of plasminogen activator inhibitor type-1 and D-dimer were greater compared with preoperative values 1 and 24 h after surgery in both groups, but their concentrations increased to a greater extent 24 h after surgery in the on-pump group (P<0.01). The concentration of C-reactive protein did not change appreciably immediately after surgery in either group but increased in a parallel manner 24 h after either on-pump or off-pump surgery (P<0.01). Bypass surgery in the on-pump group was associated with greater blood loss during surgery and more bleeding after surgery (P< or =0.01). The incidence of all other complications was similar in the two groups. CONCLUSION: On-pump surgery was associated with biochemical evidence of a prothrombotic state early after surgery but no greater incidence of thrombotic events was observed. The prothrombotic state might be a consequence of extracorporeal bypass, compensation in response to more bleeding, or both in patients undergoing on-pump surgery. SN - 1473-5830 UR - https://www.unboundmedicine.com/medline/citation/19293667/Hemostatic_changes_and_clinical_sequelae_after_on_pump_compared_with_off_pump_coronary_artery_bypass_surgery:_a_prospective_randomized_study_ L2 - https://doi.org/10.1097/MCA.0b013e3283219e8b DB - PRIME DP - Unbound Medicine ER -