title: The role of tissue factor and P-selectin in the procoagulant response that occurs in the first month after on-pump and off-pump coronary artery bypass grafting.
abstract: BACKGROUND
  It has been previously shown that a persistent (up to 1 month) prothrombotic status occurs after coronary bypass surgery performed both on pump and off pump. To assess the pathways involved in the occurrence of postoperative prothrombotic state, in this study we evaluated plasma, monocyte-bound, and platelet-bound tissue factor expression, as well as platelet and soluble P-selectin expression, up to 1 month after off-pump and on-pump coronary artery bypass grafting.
  
  
  METHODS
  Thirty patient candidates for coronary surgery were randomized to undergo off-pump coronary artery bypass grafting (n = 15) or on-pump coronary artery bypass grafting (n = 15). Blood samples were collected before the intervention, after protamine administration, and 4, 8, and 30 days after surgical intervention.
  
  
  RESULTS
  Plasma tissue factor levels were significantly higher than baseline both in the on-pump coronary artery bypass grafting group (from protamine administration up to 4 postoperative days) and in the off-pump coronary artery bypass grafting group (at 4 postoperative days), with no differences between groups. Basal and lipopolysaccharide-stimulated monocyte tissue factor expression, as well as basal and adenosine diphosphate-stimulated platelet tissue factor expression, did not show significant variations over time and were similar in the on-pump and off-pump coronary artery bypass grafting groups throughout the course of the study. Platelet expression of P-selectin, both basal and after adenosine diphosphate stimulation, did not significantly change over time and was not different in the on-pump and off-pump coronary artery bypass grafting groups. Soluble P-selectin levels in plasma were significantly higher in patients receiving on-pump coronary artery bypass grafting only at the time point after protamine administration, whereas this variable behaved similarly in the on-pump and off-pump coronary artery bypass grafting groups for the whole postoperative period.
  
  
  CONCLUSIONS
  The postoperative tissue factor and P-selectin expression did not differ between the on-pump and off-pump coronary artery bypass grafting groups. The distinct increase of plasma tissue factor occurring after both surgical procedures might represent a mechanism that might explain, in part, the early postoperative prothrombotic state occurring after on-pump and off-pump coronary artery bypass grafting.
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy. alessandro.parolari@cardiologicomonzino.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.forename: Luciana
authors.initials: L
authors.lastname: Mussoni
authors.forename: Marta
authors.initials: M
authors.lastname: Frigerio
authors.forename: Moreno
authors.initials: M
authors.lastname: Naliato
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Polvani
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
authors.forename: Marina
authors.initials: M
authors.lastname: Camera
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000096:biosynthesis* / Q000097:blood; D013925:Thromboplastin / Q000032:analysis / Q000096:biosynthesis*; D013997:Time Factors
chemical_list: D019007:P-Selectin; D013925:Thromboplastin