Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?
BACKGROUND
Hemostasis is preserved after off-pump coronary operations compared with conventional coronary procedures. However, this preserved hemostasis may result in a procoagulant activity.


METHODS
We prospectively studied coagulation in 22 patients who underwent off-pump coronary operation either through a midline sternotomy (n = 14) or with minimally invasive anterolateral thoracotomy (n = 8).


RESULTS
Procoagulant activity, represented by prothrombin factor 1 and 2, remained at baseline levels during operation but increased significantly on postoperative day 1. Factor VII remained at baseline levels during the operation but decreased significantly on postoperative day 1. Fibrinolysis was increased as indicated by the fibrin degradation products on postoperative day 1. A promoted hemostasis attributable to endothelial activation was indicated by the increase in von Willebrand factor on postoperative day 1. Platelets counts and platelet activation (beta-thromboglobulin) remained at baseline levels after the operation. No adverse clinical events occurred.


CONCLUSIONS
Patients undergoing off-pump coronary operation show an increased procoagulant activity in the first postoperative 24 hours regardless of the surgical approach (midline sternotomy or anterolateral thoracotomy). This procoagulant activity is not mediated by platelet-related factors. Therefore, a specific perioperative prophylactic pharmacologic regimen is advisable.
Mariani
M A
MA
Thoraxcenter, University Hospital of Groningen, The Netherlands. M.Mariani@thorax.azg.nl
Gu
Y J
YJ
Boonstra
P W
PW
Grandjean
J G
JG
van Oeveren
W
W
Ebels
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005167:Factor VII / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011516:Prothrombin / Q000032:analysis; D013908:Thoracotomy; D001620:beta-Thromboglobulin / Q000032:analysis
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D001620:beta-Thromboglobulin; D005167:Factor VII; D011516:Prothrombin