title: Thrombin generation during cardiopulmonary bypass using heparin-coated or standard circuits.
abstract: For quantitative comparison of thrombin generation during cardiopulmonary bypass (CPB) with heparin-coated vs conventional CPB circuits, thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2) were analyzed in 20 patients undergoing combined heart valve surgery and coronary artery bypass grafting (CABG), in ten cases with heparin-coated circuits (COMB-HC) and in ten with standard circuits (COMB-C). Extensive thrombin generation was found in both groups, with maximal TAT and F1 + 2 levels at the end of CPB. Of 15 operations with only CABG, seven were performed with heparin-coated circuits and heparin dose 40% of normal (CABG-HC), and eight with standard circuits and normal heparin doses (CABG-C). TAT was maximal at the end of CPB and F1 + 2 peaked 3 hours after protamine injection. At the end of CPB both levels were significantly higher in the CABG-HC than in the CABG-C group, though thrombin generation was less than in the COMB groups. The abundant thrombin generation during CPB thus was much more pronounced during complex operations. Use of heparin-coated circuits did not reduce thrombin generation, which was increased by 60% reduction of the systemic heparin dose. The clinical implications are still unknown, as no complications were observed.
authors.affiliation: Department of Clinical Chemistry, University Hospital, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Ernofsson
authors.forename: S
authors.initials: S
authors.lastname: Thelin
authors.forename: A
authors.initials: A
authors.lastname: Siegbahn
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology*; D000990:Antithrombin III / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D001026:Coronary Artery Bypass; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D010447:Peptide Hydrolases / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D013917:Thrombin / Q000096:biosynthesis*
chemical_list: D000925:Anticoagulants; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D011516:Prothrombin; D006493:Heparin; D010447:Peptide Hydrolases; D013917:Thrombin