Hemostasis in off-pump compared to on-pump coronary artery bypass grafting: a prospective, randomized study.
BACKGROUND
We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery.


METHODS
Thirty-one patients were randomized to on-pump or off-pump coronary artery bypass grafting. Factors of hemostasis as well as markers of endothelial activation were measured up to 24 hours after the operation: Fibrin D dimer, prothrombin fragment 1+2, alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor. Overall hemostasis potential, overall coagulation potential, and overall fibrinolysis potential were determined with a previously developed assay. We also measured platelet count before and after surgery.


RESULTS
Fibrin D dimer and prothrombin fragment 1+2 concentrations were lower during surgery in the off-pump group (p < 0.001). Four hours after admission to the intensive care unit, these differences were eliminated. alpha2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor concentrations did not differ between groups (p = 0.59, p = 0.28, p = 0.22, and p = 0.69). Protein C1 esterase inhibitor and von Willebrand factor concentrations increased over time (p < 0.001) in both groups. Overall hemostasis potential and overall coagulation potential increased over time (p < 0.001), while overall fibrinolysis potential decreased (p < 0.001) with no difference between groups (p = 0.69, p = 0.91). Platelet count decreased on the first postoperative day (p < 0.001), but increased from the first to the third postoperative day (p = 0.004) in both groups without any inter group difference (p = 0.82).


CONCLUSIONS
There was a tendency toward less activation of coagulation and fibrinolysis in low-risk patients during elective off-pump coronary artery bypass surgery when compared with on-pump surgery.
Vedin
Jenny
J
Department of Cardiothoracic Surgery and Anesthesia, Karolinska University Hospital, Stockholm, Sweden. jenny.vedin@karolinska.se
Antovic
Aleksandra
A
Ericsson
Anders
A
Vaage
Jarle
J
D000368:Aged; D001777:Blood Coagulation / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies