Enhanced Thrombin Generation After Cardiopulmonary Bypass Surgery

Abstract

After cardiac surgery, thrombin generation continues, accompanied by a high thrombin-generating capacity and elevated fibrinogen levels. This constellation suggests a marked procoagulopathic state in the postoperative period with the potential to aggravate the risk of thromboembolic complications. Warfarin treatment after AVR significantly reduced thrombin-generating capacity.

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

“…Evidence suggests that aspirin resistance is common within the first week after cardiac surgery and the standard low‐dose aspirin (100 mg/day) would not be adequate to exert its full antiplatelet effects in many patients 11, 12, 13. Because cardiac surgical patients are also prothrombotic postsurgery (up to 30 days),6, 7, 8, 9 use of low‐dose antiplatelet agents alone would not be sufficient in preventing VTE during this high‐risk period if the patients have multiple risk factors for VTE (Table 3). We noted that fatal PE after cardiac surgery still occurred within the last decade despite advances in cardiac surgical care, including routine use of low‐dose aspirin post‐CABG 23, 26, 71, 73, 77.…”

“…Recent evidence suggested that a prothrombotic state owing to multiple mechanisms, including increased fibrinogen concentrations, thrombin generation, tissue factor activation, reduced fibrinolysis, return of normal platelet aggregation, and aspirin resistance, [6][7][8][9][10][11][12][13] is common after cardiac surgery from postoperative day 1, reaches a peak prothrombotic state between day 3 and day 5 after surgery, [6][7][8][9] and can last up to 30 days postsurgery. 6 Therefore, patients after cardiac surgery are not necessarily protected from VTE from day 1 postoperatively, despite their tendency for bleeding during the intraoperative and immediate postoperative period.…”

Vorapaxar in patients with coronary artery bypass grafting: Findings from the TRA 2°P-TIMI 50 trial

“…Thrombin generation is increased both during and after CABG and plausibly plays a significant role in the high rates of perioperative thrombosis. 22,23 Because vorapaxar has been shown to provide potent PAR-1 blockade for more than seven days after cessation of treatment, it has the potential capacity to blunt the pro-thrombotic effects of increased thrombin generation during CABG. 24 In addition, neointimal hyperplasia has been shown to be driven by PAR-1 activation in vascular smooth muscle cells.…”

Spinal epidural hematoma related to an epidural catheter in a cardiac surgery patient -A case report-

“…Our patient experienced postoperative coagulation abnormalities, including prolonged PT and thrombocytopenia. However, the abnormalities were not treated to keep anticoagulated state to prevent thromboembolic event caused by enhanced thrombin generation after cardiopulmonary bypass surgery [9]. While he seemed to be neurologically intact during the immediate postoperative period, neurologic abnormalities were observed the next morning on the first operative day, after 16 hours from the end of operation.…”