Document Detail

Activation of coagulation and fibrinolysis during coronary surgery: on-pump versus off-pump techniques.
MedLine Citation:
PMID:  11684978     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The authors studied the changes in selected hemostatic variables in patients undergoing coronary surgery with on-pump coronary artery bypass grafting (CABG) or off-pump coronary artery bypass surgery (OPCAB) techniques. METHODS: Platelet counts and plasma concentrations of antithrombin, fibrinogen, D dimer, alpha(2) antiplasmin, and plasminogen were measured preoperatively, 5 min after administration of heparin, 10 min after arrival in the intensive care unit, and 24 h after surgery in patients scheduled to undergo OPCAB (n = 15) or CABG (n = 15). To correct for dilution, hemostatic variables and platelet counts were adjusted for the changes in immunoglobulin G plasma concentrations and hematocrit, respectively. RESULTS: Adjusting for dilution, antithrombin and fibrinogen concentrations decreased to a similar extent in patients undergoing OPCAB or CABG (pooled means and 95% confidence limits of the mean: 95.5% of baseline, 93-98%, P = 0.002, and 91.7% of baseline, 88-95%, P = 0.0001), respectively, whereas alpha(2)-antiplasmin concentrations were unchanged. Only CABG was associated with a reduction in platelet counts (76% of baseline, 66-85%, P = 0.0001), plasminogen concentrations (96% of baseline, 91-99%, P = 0.011), and increased D-dimer formation (476%, 309-741%, P = 0.004). Twenty-four hours after surgery, platelet counts were still lower in patients undergoing CABG (P = 0.049), but all the investigated variables adjusted for dilution were similar in the two groups. CONCLUSIONS: Coronary surgery causes a net consumption of antithrombin and fibrinogen. A transient decrease in platelet counts, with plasminogen activation and increased D-dimer formation, however, is only observed with CABG. Twenty-four hours after surgery, the hemostatic profiles of patients in both groups are similar.
V Casati; C Gerli; A Franco; P Della Valle; S Benussi; O Alfieri; G Torri; A D'Angelo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  95     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-10-30     Completed Date:  2001-12-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1103-9     Citation Subset:  AIM; IM    
Department of Anesthesiology, University of Milan, Italy.
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MeSH Terms
Blood Coagulation*
Coronary Artery Bypass / methods*
Fibrin Fibrinogen Degradation Products / metabolism
Immunoglobulin G / blood
Middle Aged
Plasminogen / metabolism
Platelet Count
Postoperative Period
Prospective Studies
Reg. No./Substance:
0/Fibrin Fibrinogen Degradation Products; 0/Immunoglobulin G; 0/fibrin fragment D; 9001-91-6/Plasminogen

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