Document Detail


Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery.
MedLine Citation:
PMID:  19820236     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Low levels of antithrombin (AT) have been independently associated with prolonged intensive care unit stay and an increased incidence of neurologic and thromboembolic events after cardiac surgery. We hypothesized that perioperative AT activity is independently associated with postoperative major adverse cardiac events (MACEs) in patients undergoing coronary artery bypass graft (CABG) surgery.
METHODS: We prospectively studied 1403 patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (http://clinicaltrials.gov/show/NCT00281164). The primary clinical end point was occurrence of MACE, defined as a composite outcome of any one or more of the following: postoperative death, reoperation for coronary graft occlusion, myocardial infarction, stroke, pulmonary embolism, or cardiac arrest until first hospital discharge. Plasma AT activity was measured before surgery, after post-CPB protamine, and on postoperative days (PODs) 1-5. Multivariate logistic regression modeling was performed to estimate the independent effect of perioperative AT activity upon MACE.
RESULTS: MACE occurred in 146 patients (10.4%), consisting of postoperative mortality (n = 12), myocardial infarction (n = 108), stroke (n = 17), pulmonary embolism (n = 8), cardiac arrest (n = 16), or a subsequent postoperative or catheter-based treatment for graft occlusion (n = 6). AT activity at baseline did not differ between patients with (0.91 ± 0.13 IU/mL; n = 146) and without (0.92 ± 0.13 IU/mL; n = 1257) (P = 0.18) MACE. AT activity in both groups was markedly reduced immediately after CPB and recovered to baseline values over the ensuing 5 PODs. Postoperative AT activity was significantly lower in patients with MACE than those without MACE. After adjustment for clinical predictors of MACE, AT activity on PODs 2 and 3 was associated with MACE.
CONCLUSIONS: Preoperative AT activity is not associated with MACE after CABG surgery. MACE is independently associated with postoperative AT activity but only at time points occurring predominantly after the MACE.
Authors:
Sean Garvin; Jochen D Muehlschlegel; Tjörvi E Perry; Junliang Chen; Kuang-Yu Liu; Amanda A Fox; Charles D Collard; Sary F Aranki; Stanton K Shernan; Simon C Body
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-10-09
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2010-10-11     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  862-9     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00281164
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Animals
Antithrombin III / metabolism*
Cardiovascular Diseases / diagnosis,  etiology,  metabolism*
Cattle
Cohort Studies
Coronary Artery Bypass / adverse effects*
Female
Heparin / blood*
Humans
Longitudinal Studies
Male
Middle Aged
Postoperative Complications / etiology,  metabolism*
Postoperative Period
Preoperative Care
Preoperative Period*
Prospective Studies
Swine
Grant Support
ID/Acronym/Agency:
K23 HL068774/HL/NHLBI NIH HHS; K23 HL068774-01A1/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9000-94-6/Antithrombin III; 9005-49-6/Heparin
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