Increased prothrombotic state lasting as long as one month after on-pump and off-pump coronary surgery.
OBJECTIVE
This study investigated whether the activation of coagulation, fibrinolysis, and endothelium occurring during the first postoperative month after on-pump coronary artery bypass surgery differs from that after off-pump coronary artery bypass grafting.


METHODS
Thirty-five patients candidates to coronary surgery were randomized to undergo on-pump (n = 18) or off-pump (n = 17) coronary artery bypass grafting. Blood samples were collected before the intervention and to 1 month after surgery.


RESULTS
Prothrombin fragment F1.2, thrombin-antithrombin complex, and D-dimer increased after surgery and were persistently higher than preoperative values as late as 30 postoperative days in both on- and off-pump groups; higher levels of these variables were detected after on-pump surgery relative to off-pump surgery only at the time point after termination of cardiopulmonary bypass (fragment F1.2 and thrombin-antithrombin complex) or from bypass end to 8 postoperative days (D-dimer). Fibrinogen levels decreased after surgery and then increased in parallel in both groups to 8 days after surgery. The von Willebrand factor level increased postoperatively in both groups and returned to baseline 30 days after surgery; it was higher after on-pump surgery from bypass end to 8 postoperative days. Soluble vascular cell adhesion molecule 1 was increased significantly from baseline in both groups 30 days after surgery, with no difference between groups.


CONCLUSIONS
Patients undergoing off-pump surgery showed protection against activation of coagulation and fibrinolysis and against endothelial injury only during the intraoperative period; this was followed by the development of a prothrombotic pattern comparable to that of patients undergoing on-pump surgery lasting at least as late as 30 days after surgery.
Parolari
Alessandro
A
Department of Cardiac Surgery, University of Milan, Italy. alessandro.parolari@cardiologicomonzino.it
Mussoni
Luciana
L
Frigerio
Marta
M
Naliato
Moreno
M
Alamanni
Francesco
F
Galanti
Andrea
A
Fiore
Giuseppe
G
Veglia
Fabrizio
F
Tremoli
Elena
E
Biglioli
Paolo
P
Camera
Marina
M
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; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000097:blood / Q000209:etiology*; D013997:Time Factors; D014652:Vascular Diseases / Q000209:etiology