Fibrinolysis in coronary artery surgery: detection by thromboelastography.
Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of assessment (P=0.003) and at 150 min of assessment (P<0.001), the mean values of these parameters were significantly lower in group A as compared with both groups B and C, which were statistically indistinguishable. Lysis on set time on the completion of peripheral bypass anastomoses <50% was detected in 12 patients (52.2%) originating from group A. At the other sampling times (preoperatively, 15 min after sternotomy, at the end of the procedures, and 24 h later) thromboelastographic parameters were similar in all groups. In group A no significant correlations between lysis on set time, postoperative blood loss and D-dimer levels were found. Based on our results, thromboelastographic signs of fibrinolysis were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C.
Vanek
Tomas
T
Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Czech Republic. vanek@fnkv.cz
Jares
Martin
M
Snircova
Jana
J
Maly
Marek
M
D000714:Anastomosis, Surgical; D001672:Biocompatible Materials; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D004867:Equipment Design; D017707:Erythrocyte Transfusion; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D017202:Myocardial Ischemia / Q000097:blood / Q000601:surgery*; D011446:Prospective Studies; D013916:Thrombelastography; D013997:Time Factors; D016896:Treatment Outcome
D001672:Biocompatible Materials; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D