Inflammatory response and platelet activation after off-pump coronary artery bypass surgery.
BACKGROUND
Cardiac surgery induces a systemic inflammatory activation and alterations in the hemostatic cascade. The responses contribute to postoperative complications but may also have protective effects. We investigated the relationship between inflammation, hemostasis and bleeding after off-pump coronary artery bypass surgery (OPCAB).


METHODS
Ten OPCAB patients were included in a prospective descriptive study. Selected markers of inflammation (IL-6, IL-8, PMN-elastase, C3a, and SC5b-9), and hemostasis (platelet count, ss-thromboglobulin, anti-thrombin, D-dimer and fibrinogen) were measured before and immediately after surgery. Postoperative bleeding was registered.


RESULTS
Inflammatory variables did not alter significantly during surgery while ss-thromboglobulin concentrations increased and anti-thrombin and fibrinogen decreased. There were significant postoperative correlations between PMN-elastase and ss-thromboglobulin (r=0.82, p=0.004), between PMN-elastase and fibrinogen (r=0.69, p=0.03) and between C3a and ss-thromboglobulin (r=0.71, p=0.02). In addition, there were significant inverse correlations between postoperative bleeding and pre- and postoperative fibrinogen levels (r=-0.76, p=0.011 and r=-0.84, p=0.002 respectively), between bleeding and postoperative ss-thromboglobulin levels (r=-0.66, p=0.04) and between bleeding and postoperative PMN-elastase (r=-0.75, p=0.01).


CONCLUSIONS
The results give further evidence for an association between the inflammatory response and hemostasis after cardiac surgery.
Aljassim
Obaid
O
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Karlsson
Martin
M
Wiklund
Lars
L
Jeppsson
Anders
A
Olsson
Per
P
Berglin
Eva
E
D000368:Aged; D015926:Complement C3a / Q000096:biosynthesis; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006331:Heart Diseases / Q000097:blood / Q000276:immunology / Q000601:surgery*; D006400:Hematocrit; D006487:Hemostasis; D006801:Humans; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation; D019106:Postoperative Hemorrhage / Q000097:blood / Q000276:immunology; D011184:Postoperative Period; D001620:beta-Thromboglobulin / Q000096:biosynthesis
D001620:beta-Thromboglobulin; D015926:Complement C3a; D005340:Fibrinogen; D019272:Leukocyte Elastase