Platelet-dependent thrombography gives a distinct pattern of in vitro thrombin generation after surgery with cardio-pulmonary bypass: potential implications

Said, Rose; Régnault, V.; Hacquard, Marie; Carteaux, Jean‐Pierre; Lecompte, Thomas

doi:10.1186/1477-9560-10-15

Cited by 3 publications

(3 citation statements)

References 17 publications

(23 reference statements)

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“…The TF concentration in itself is also debatable. The concentration we utilized has been used in several studies [ 10 , 12 , 31 ] and our sampling took place after heparin reversal. In spite of randomization, the control group had somewhat longer CPB and clamp time.…”

Section: Discussionmentioning

confidence: 99%

Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study

et al. 2015

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BackgroundBleeding complications are common in cardiac surgery. Perioperative handling of heparin and protamine may influence the haemostasis. We hypothesized that heparin and protamine dosing based on individual titration curves would improve haemostasis in comparison to standard dosing.Subjects and MethodsSixty patients scheduled for first time elective coronary artery bypass grafting or valve surgery were included in a prospective randomized study. The patients were randomized to heparin and protamine dosing with Hepcon HMS Plus device or to standard weight and activated clotting time (ACT) based dosing. Blood samples were collected before and 10 minutes, 2 hours and 4 hours after cardiopulmonary bypass. Primary endpoint was endogenous thrombin potential in plasma 2 hours after surgery as assessed by calibrated automated thrombography. Secondary endpoints included total heparin and protamine doses, whole blood clot formation (thromboelastometry) and post-operative bleeding volume and transfusions. Heparin effect was assessed by measuring anti-Xa activity.ResultsEndogenous thrombin potential and clot formation deteriorated in both groups after surgery without statistically significant intergroup difference. There were no significant differences between the groups in total heparin and protamine doses, heparin effect, or postoperative bleeding and transfusions at any time point. Significant inverse correlations between anti-Xa activity and endogenous thrombin potential were observed 10 min (r = -0.43, p = 0.001), 2 hours (r = -0.66, p<0.001) and 4 hours after surgery (r = -0.58, p<0.001).ConclusionIn conclusion, the results suggest that perioperative heparin and protamine dosing based on individual titration curves does not improve haemostasis after cardiac surgery. Postoperative thrombin generation capacity correlates to residual heparin effect.Trial Registration www.isrctn.com ISRCTN14201041.

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Section: Discussionmentioning

confidence: 99%

Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study

et al. 2015

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“…Furthermore, an increase was observed in time parameters compared with the preoperative values and the control group. The findings indicated that platelet dysfunction worsened during CABG because of the following factors: Blood contact with the synthetic surfaces of the extracorporeal circuit, resulting in degranulated platelets after CPB [ 21 ]; The use of heparin, which inhibits thrombin activity and binds to antithrombin III, contributing to its inactivation, inhibition of thrombus formation, and development of heparin-induced thrombocytopenia [ 8, 15 ]; The use of protamine to neutralize heparin, which in a dose-dependent manner alters the structure of the fibrin clot, reducing platelet function and increasing the ACT [ 18 ]; Hemodilution coagulopathy [ 5 ], both due to mechanical blood dilution and the direct interaction of the molecules of colloid volume expanders with platelet membranes, causing the blockage of platelet fibrinogen receptors – GP IIb/IIIa [ 10, 11 ]; Hypothermia and acidosis, which leads to damages in the initial stages of thrombus formation (initiation phase) and clot formation (proliferation phase) [ 14 ]. …”

Section: Discussionmentioning

confidence: 99%

“…Blood contact with the synthetic surfaces of the extracorporeal circuit, resulting in degranulated platelets after CPB [ 21 ];…”

Section: Discussionmentioning

confidence: 99%

Use of thrombin generation test for monitoring hemostasis in coronary bypass surgery

Груздева

Uchasova

Fanaskova

et al. 2017

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To evaluate the parameters of the thrombin generation test (TGT) in coronary artery disease (CAD) patients on prolonged aspirin therapy during on-pump coronary artery bypass grafting (CABG) after donor platelet concentrate transfusion. A total of 148 patients with CAD on prolonged aspirin therapy (75–100 mg/day) who have undergone elective on-pump CABG were consecutively included in the study. Patients were divided randomly into two groups. Group 1 (n = 76) received donor platelet transfusions after cardiopulmonary bypass, whereas Group 2 (n = 72) did not. TGT parameters were measured using an analyzer at pre-, intra-, and early postoperative periods. Activation of the endogenous thrombin potential was observed in patients on prolonged aspirin therapy in the pre- and intraoperative periods, as confirmed by high peak thrombin and increased velocity index. The activation time of the prothrombinase complex and thrombin generation time were greater than the control group. The blood hemostatic potential in patients who did not receive transfusions in the early postoperative period decreased up to the level of the control group in the extended time parameters. Hemostatic potential in plasma in patients on aspirin was preserved. Given the laboratory test results and clinical data, platelet concentrate transfusion is unnecessary for prevention.

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Evaluation of the hemostatic potential at coronary artery bypass surgery during long-term aspirin therapy

Груздева

Fanaskova

Акбашева

et al. 2016

Terapevticheskii arkhiv

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The hemostatic potential was preserved in patients receiving long-term therapy for ASA. Taking into account laboratory and clinical findings, platelet concentrate transfusions are unnecessary for preventive purposes. The appropriateness of donor platelet transfusion should be strictly individually approached with regard to the laboratory parameters of the thrombin generation test, by minimizing the risk of perioperative ischemic and hemorrhagic events in each specific patient.

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Platelet-dependent thrombography gives a distinct pattern of in vitro thrombin generation after surgery with cardio-pulmonary bypass: potential implications

Cited by 3 publications

References 17 publications

Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study

Heparin and Protamine Titration Does Not Improve Haemostasis after Cardiac Surgery: A Prospective Randomized Study

Use of thrombin generation test for monitoring hemostasis in coronary bypass surgery

Evaluation of the hemostatic potential at coronary artery bypass surgery during long-term aspirin therapy

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