Impact of diabetes mellitus on coagulation function before and after off-pump coronary artery bypass grafting

Abstract

Background: This study aims to explore the influence of off-pump coronary artery bypass grafting (OPCABG) on coagulation function and the effects of diabetes on coagulation function during OPCABG.Methods: Patients who met the inclusion and exclusion criteria were divided into two groups: diabetes mellitus (DM) and non-diabetes mellitus (NDM) groups. Thromboelastography (TEG) was tested at the following time points: T0, five days after aspirin and clopidogrel therapy, and before OPCABG; T1, returning to care unit after OPCABG; T2, 5 days after aspirin and clopidogrel therapy, and after OPCABG.Results: A total of 56 patients were involved. There were no deaths, or no early postoperative thrombotic events and abnormal bleeding after OPCABG. Intra-group comparison: Compared with T0, the R and K value decreased, while the α angle and MA value increased at T1 and T2, in both groups (P<0.05). A significantly statistical difference was found in the multiple comparison at T0, T1 and T2 (P<0.05). The results are as follows: the R value decreased at T1 and increased at T2, but the value remained less than that at T0. After the OPCABG, the K value gradually decreased, while the MA value and α angle gradually increased. Comparison between groups: T1: the R values were lower in the DM group, when compared to the NDM group (t=3.611, P=0.001). The differences in the MA, K and α angle were not statistically significant. T0 and T2: there were no statistically difference in the R, MA, K, α angle and LY30 between the two groups (P>0.05). Conclusions:The coagulation function of patients was at a hypercoagulable state at the early stage after OPCABG. The coagulation function was affected by diabetes at the day of OPCABG. However, there was no statistical difference after 5 days of aspirin and clopidogrel therapy following OPCABG.

The Effect of Off‐Pump Coronary Artery Bypass Grafting in Patients on Aspirin Therapy until Surgery Day

“…Aspirin is the main therapeutic drug for preventing graft occlusion after coronary artery bypass grafting (CABG) [ 15 – 17 ]. It has been shown to prevent graft failure in patients undergoing coronary artery bypass grafting and ischemic complications such as myocardial infarction and stroke [ 18 ].…”

Detection of Hemostasis Abnormalities in Type 2 Diabetes Mellitus Using Thromboelastography

“…Several studies of TEG in T2DM compared the diabetes group with a healthy control group and only a few studies analyzed the correlation between hemostasis and glycemic profile and the type of therapy for diabetes. 7,12,16 Therefore, the current study aimed to detect hemostasis abnormalities in association with glycemic levels and type of therapy among patients with T2DM by using TEG.…”

“…[31][32][33] A study by Xie et al, 34 revealed a decrease in R-value among patients with gestational diabetes mellitus which was not observed in normal pregnancy. Wang et al, 16 also obtained a lower R-value in acute stress after surgery among patients with DM compared to non-DM. Hyperglycemic condition combined with hyperinsulinemia may activate the coagulation system by increasing the activation of TF, FVII, FVIII, and platelet.…”

“…Higher glycemic levels in the hypocoagulable group might monitoring of acute conditions. 11,[16][17][18][19] Therefore, TEG might be less sensitive and less specific in detecting hemostasis abnormalities in subjects without acute critical comorbidities. Although several studies indicated significant associations between acute and chronic hyperglycemia with hemostasis abnormalities, those associations were not consistently found in all parameters of hemostasis and all subsets of T2DM patients.…”

Prevalence and Impact of Fibrinolytic Dysregulation in Patients with Acute Coronary Syndromes

“…[7,8] Notably, either TEG detected hyper brinolysis or brinolysis shutdown was related to poor prognosis in patients with trauma or severe diseases. [9][10][11][12] In patients with CHDs, modi ed TEG was applied to measure platelet reactivity [13,14] and coagulation function [15]. However, little is known about abnormal brinolysis in patients with CHDs.…”