Coagulation and fibrinolytic markers in a two-month follow-up of coronary bypass surgery.
OBJECTIVE
The alterations of the coagulation-fibrinolytic profile immediately and up to few days after cardiac surgery have been widely documented. However, less information is available on whether these alterations persist for prolonged periods of time after the operation. In this study we have evaluated the coagulation-fibrinolytic profile of patients who underwent coronary artery surgery with cardiopulmonary bypass during a 2-month follow-up period.


METHODS
Twenty-six patients (age range, 50-75 years) were studied. Blood samples were collected before the intervention and at different time points postoperatively up to 2 months after the operation. Measurement of selected coagulation-fibrinolytic variables was carried out in plasma from 16 patients. Evaluation of tissue factor activity determined as procoagulant activity was performed in peripheral blood mononuclear leukocytes obtained from 10 patients.


RESULTS
Antigenic levels of clottable fibrinogen, prothrombin fragment F1.2, D-dimer, and thrombin-antithrombin complex were significantly increased during the first week after the intervention compared with preoperative values. Prothrombin fragment F1.2 levels returned to normal within 15 days, fibrinogen levels normalized within 30 days, and thrombin-antithrombin complex levels normalized at 45 days, whereas D-dimer values were still significantly higher 60 days postoperatively respective to baseline values. There was a trend toward an increased procoagulant activity from peripheral blood mononuclear leukocytes 4 days after the operation, whereas no changes of factor VII measured either as antigen or in its coagulant and activated forms were recorded throughout the study.


CONCLUSIONS
A marked activation of the coagulation-fibrinolytic system occurs after cardiopulmonary bypass and lasts for at least 2 months thereafter. This finding suggests that these alterations might account for the increased thrombotic risk of these patients during the postoperative period.
Parolari
Alessandro
A
Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Italy. alessandro.parolari@cardiologicomonzino.it
Colli
Susanna
S
Mussoni
Luciana
L
Eligini
Sonia
S
Naliato
Moreno
M
Wang
Xin
X
Gandini
Sara
S
Tremoli
Elena
E
Biglioli
Paolo
P
Alamanni
Francesco
F
D000368:Aged; D000990:Antithrombin III; D015415:Biomarkers / Q000097:blood*; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D010447:Peptide Hydrolases / Q000097:blood*; D011516:Prothrombin; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology; D013997:Time Factors
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D005340:Fibrinogen; D010447:Peptide Hydrolases