One Month Follow-up of Haemostatic Variables in Patients Undergoing Aortocoronary Bypass Surgery

Abstract

SummaryIt is already known that activation of the coagulation and fibrinolytic system occurs in patients undergoing cardiopulmonary bypass (CPB). We have thus studied twenty patients (10 treated with aprotinin during CPB and 10 untreated) both during the intraoperative period and during thirty days follow up. In untreated patients D-dimer levels increased 4-fold during CPB and the levels were above baseline for the whole follow up (p<0.0001). D-dimer levels were reduced in aprotinin treated patients in comparison to untreated patients (p = 0.0172); levels then gradually increased to the values of the untreated patients over the following 24 h later and remained higher during the thirty day follow up. The behavior of haemostatic variables in the 24 h after CPB did not vary between untreated and aprotinin treated patients. In particular, five minutes after protamine sulphate administration, levels of F1 + 2 and TAT rose significantly (p = 0.0054, p = 0.0022 respectively), whereas fibrinogen significantly decreased (p<0.0001) and PAI-1 antigen levels were reduced. Two days after CPB the concentrations of F1 + 2 and TAT lowered, whereas fibrinogen and PAI-1 antigen levels increased. On the 5th, 8th and 30th days after CPB, F1 + 2 and TAT levels remained higher than those reported at baseline in both groups of patients, whereas fibrinogen levels increased over basal levels in aprotinin treated patients only.Thus, in addition to the activation of the coagulation and fibrinolytic system occurring during the intraoperative period, in patients undergoing CPB, there are alterations of haemostatic variables up to thirty days from surgery.

Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system

“…Interestingly, no differences in terms of endothelial or platelets activation markers were observed during the surgical procedure under different extracorporeal bypass conditions. In contrast, our study showed a significant elevation of TATc, F 1C2 and PAPc levels in the CPB group, which were confirmed by previous studies by Mannucci [13] and Ovrum [12]. During and early after cardiac surgery performed with CPB the authors demonstrated marked activation of coagulation by means of elevated levels of prothrombin fragment 1.2, and of thrombinantithrombin complex followed by a marked activation of the fibrinolytic system.…”

Impact of Clopidogrel in Patients With Acute Coronary Syndromes Requiring Coronary Artery Bypass Surgery

“…response with complete recovery of platelet function 7 days after the last dose (18). Because cardiothoracic surgery represents a major hemostatic challenge (19) and is required in upward of 15% of patients admitted to the hospital with ACS (7-9), clinicians are confronted regularly with complex decisions concerning clopidogrel cessation and surgical revascularization. In fact, data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) initiative noted that 30% of patients undergoing CABG received clopidogrel on admission for ACS, and 87% of these patients went to surgery Յ5 days from their last clopidogrel dose (9).…”

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

“…In operations using cardiopulmonary bypass, additional massive activation of coagulation by the contact of blood with foreign, negatively charged, nonendothelial surfaces is described with presumable consequent activation of the fibrinolytic system. 16) A very important mechanism acti- vating the coagulation-fibrinolytic system seems to be retransfusion of pericardial blood collected intraoperatively to the extracorporeal circuit, as this shed blood contains a great amount of tissue factor and tissue plasminogen activator. 17) For this reason, a strategy based on the use of biocompatible surfaces with low thrombogenicity (eg.…”