Document Detail


Effect of cardiopulmonary bypass on thrombin generation and protein C pathway.
MedLine Citation:
PMID:  23312776     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate the mechanisms of cardiopulmonary bypass (CPB)-induced dysregulation between thrombin and its regulatory anticoagulant activated protein C (APC).
DESIGN: A prospective observational cohort study.
SETTING: A tertiary care university hospital and associated research laboratory.
PATIENTS: Twenty patients undergoing elective coronary artery bypass surgery with (n = 10) or without CPB (n = 10).
INTERVENTIONS: Blood samples were collected at 7 time points: preinduction; after heparin; 1 hour after the institution of CPB (or the completion of distal anastomoses in off-CPB group); after protamine; and at 0, 4, and 18 hours in the Intensive care unit (ICU). Samples were analyzed for prothrombin fragments (F1+2), thrombin-antithrombin complexes, protein C (PC), APC, soluble thrombomodulin (sTM), and soluble endothelial protein C receptor (sEPCR).
MEASUREMENTS AND MAIN RESULTS: F1+2 levels increased significantly 1 hour after the initiation of CPB in comparison with baseline (2.7 ± 0.5 v 0.5 ± 0.2 nmol/L, p < 0.001) (mean ± standard deviation) and remained elevated until 4 hours after ICU admission (p < 0.001). In contrast, APC levels did not show any significant changes over time in either group. sEPCR, sTM, and PC levels did not change during CPB although sEPCR decreased significantly after the termination of CPB compared with baseline in the CPB group.
CONCLUSIONS: Exposure to CPB is associated with a distinct thrombin surge that continues postoperatively for 4 hours. The impaired ability to generate APC reflects a complex process that is not associated with increased levels of sEPCR and thrombomodulin during CPB. Further studies are required to evaluate the regulation of the host APC response in cardiac surgery.
Authors:
Ravi Taneja; Patricia L Liaw; Samer Al Ghazaly; Fran Priestap; John M Murkin; Claudio M Martin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  27     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  35-40     Citation Subset:  IM    
Copyright Information:
Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.
Affiliation:
Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada; Division of Critical Care Medicine, Department of Medicine, University of Western Ontario, London, Ontario, Canada; Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada. Electronic address: ravi.taneja@lhsc.on.ca.
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