Coagulation system activity before coronary artery bypass surgery for unstable angina.
OBJECTIVE
To measure coagulation activity immediately prior to coronary artery bypass surgery. Previous reports have shown that a hypercoagulable state and reduced fibrinolytic activity increase the risk of postoperative graft failure.


METHODS
Fifty patients with unstable angina and ongoing low-molecular-weight heparin antithrombotic treatment for a median of 4 days and 25 stable patients undergoing elective surgery were included.


RESULTS
Antithrombin levels were significantly lower whereas fibrinogen and plasminogen activator inhibitor-1 levels were higher in the unstable patients than in the stable patients. Median preoperative levels of thrombin-antithrombin complex (TAT), prothrombin fragment1+2 (F1+2), fibrin D-dimers and beta-thromboglobulin did not differ significantly in unstable and stable patients. There were signs of activated coagulation with elevated levels of TAT and F1+2 before the operation in half of the unstable patients, who had had chest pain at rest within 48 h preceding the operation and also in one-third of patients undergoing elective surgery.


CONCLUSIONS
A hypercoagulable state may be present in unstable as well as in stable angina pectoris patients accepted for coronary artery bypass surgery.
Bjessmo
S
S
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden. staffan.bjessmo@swipnet.se. staffan.bjessmo@swipnet.se
Ivert
T
T
Egberg
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood / Q000601:surgery*; D000990:Antithrombin III; D000991:Antithrombins / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D001026:Coronary Artery Bypass; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D010447:Peptide Hydrolases / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D011516:Prothrombin; D001620:beta-Thromboglobulin / Q000032:analysis
D000991:Antithrombins; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D017395:Plasminogen Activator Inhibitor 1; C046193:antithrombin III-protease complex; D001620:beta-Thromboglobulin; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D005340:Fibrinogen; D010447:Peptide Hydrolases