Coagulation activation and organ dysfunction following cardiac surgery.
OBJECTIVE
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with major inflammatory triggers that cause marked activation of the microcirculation. This inflammatory response is associated with significant organ dysfunction. How this response causes organ dysfunction is not well understood; consequently, few interventions exist to prevent or treat it. In other acute inflammatory conditions, such as sepsis, increased coagulation activation in the microcirculation may be a cause of organ injury. We documented the association between coagulation activation and organ dysfunction to investigate whether coagulation activation also plays a role in organ injury following cardiac surgery with CPB.


METHODS
Prospective study of 30 patients undergoing cardiac surgery with CPB. Prothrombin fragment (PTF) 1 + 2 and plasminogen activator inhibitor (PAI) activity were measured, and levels correlated with postoperative measures of organ function including the left-ventricular stroke work index, the Pao(2)/fraction of inspired oxygen (Fio(2)) ratio, and creatinine levels.


RESULTS
PTF levels increased eightfold (p < 0.05), and PAI activity increased threefold (p < 0.05) over the first 4 h after CPB. PTF levels were correlated with deteriorations in the left-ventricular stroke work index (p = 0.04), the Pao(2)/Fio(2) ratio (p = 0.02), and creatinine levels (p = 0.02).


CONCLUSIONS
Levels of coagulation activation are associated with markers of postoperative organ dysfunction. Additional studies are warranted to investigate whether strategies that limit coagulation activation are associated with reductions in postoperative organ dysfunction.
Intensive Care, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia. barry.dixon@svhm.org.au
Barry
B
Dixon
John
J
Santamaria
Duncan
D
Campbell
D000368:Aged; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007677:Kidney Function Tests; D016014:Linear Models; D008297:Male; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood; D015849:Plasminogen Inactivators / Q000097:blood; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D014914:Whole Blood Coagulation Time
D010446:Peptide Fragments; D015849:Plasminogen Inactivators; D011498:Protein Precursors; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D011516:Prothrombin; D003404:Creatinine