Document Detail

Thrombin generation during reperfusion after coronary artery bypass surgery associates with postoperative myocardial damage.
MedLine Citation:
PMID:  16839349     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiopulmonary bypass and coronary artery bypass grafting (CABG) result in significant thrombin generation and activation of fibrinolysis. Thrombin contributes to myocardial ischemia-reperfusion injury in animal studies, but the role of thrombin in myocardial damage after CABG is unknown. OBJECTIVES: We measured thrombin generation and fibrin turnover during reperfusion after CABG to evaluate their associations with postoperative hemodynamic changes and myocardial damage. METHODS: One hundred patients undergoing primary, elective, on-pump CABG were prospectively enrolled. Plasma prothrombin fragment F(1+2) and D-dimer were measured preoperatively and at seven time points thereafter. Mass of the Mb fraction of creatine kinase (Ck-Mbm) and troponin T (TnT) were measured on the first postoperative day. RESULTS: Reperfusion induced an escalation of thrombin generation and fibrin turnover despite full heparinization. F(1+2) during early reperfusion associated with postoperative pulmonary vascular resistance index. F(1+2) at 6 h after protamine administration correlated with Ck-Mbm (r = 0.40, P < 0.001) and TnT (r = 0.44, P < 0.001) at 18 h postoperatively. Patients with evidence of myocardial damage (highest quintiles of plasma Ck-Mbm and TnT) had significantly higher F(1+2) during reperfusion than others (P < 0.002). Logistic regression models identified F(1+2) during reperfusion to independently associate with postoperative myocardial damage (odds ratios 2.5-4.4, 95% confidence intervals 1.04-15.7). CONCLUSIONS: Reperfusion caused a burst in thrombin generation and fibrin turnover despite generous heparinization. Thrombin generation during reperfusion after CABG associated with pulmonary vascular resistance and postoperative myocardial damage.
P Raivio; A Kuitunen; R Suojaranta-Ylinen; R Lassila; J Petäjä
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  4     ISSN:  1538-7933     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-14     Completed Date:  2006-10-06     Revised Date:  2006-11-20    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  1523-9     Citation Subset:  IM    
Department of Cardiothoracic Surgery, Helsinki University Central Hospital, FIN-00029 HUS, Helsinki, Finland.
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MeSH Terms
Aged, 80 and over
Coronary Artery Bypass / adverse effects*
Fibrin / metabolism
Heparin / therapeutic use
Middle Aged
Myocardial Ischemia / diagnosis*,  etiology
Postoperative Complications / etiology
Prospective Studies
Reperfusion Injury / complications*
Thrombin / biosynthesis*
Reg. No./Substance:
9001-31-4/Fibrin; 9005-49-6/Heparin; EC
Erratum In:
J Thromb Haemost. 2006 Nov;4(11):2519

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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