Inflammatory and hemostatic activation in patients undergoing off-pump coronary artery bypass grafting.
To characterize hemostatic differences imposed by 2 common cardiac surgeries, the authors studied patients undergoing coronary artery revascularization by off-pump (n = 13) or cardiopulmonary bypass on-pump (n = 26) technique. Blood samples collected to 4 days post-surgery were evaluated by flow cytometry and enzyme-linked immunosorbent assay. A significant inflammatory response occurred in both the groups after surgery shown by increased interleukin cytokines and C-reactive protein; however, levels peaked lower and hours later in the off-pump group. Platelets (P-selectin; platelet-leukocyte complexes) and leukocytes (CD11b) were activated only in on-pump patients. Thrombin generation was enhanced in both groups after surgery. Only in the on-pump patients, the thrombin-antithrombin complex, pro-thrombin fragment 1.2, and thrombomodulin (vascular integrity) decreased intraoperatively. Tissue plasminogen activator and plasminogen activator inhibitor-1 were greater in the on-pump patients. Off-pump surgery may place patients at higher risk of postoperative hypercoagulability because of normal platelet function, intraoperative thrombin generation, less fibrinolytic activity, and lack of vascular protection.
Untch
Brian R
BR
Department of Thoracic and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL 60153, USA.
Jeske
Walter P
WP
Schwartz
Jeffrey
J
Botkin
Sally
S
Prechel
Margaret
M
Walenga
Jeanine M
JM
Bakhos
Mamdouh
M
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006487:Hemostasis; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D011446:Prospective Studies; D013917:Thrombin / Q000096:biosynthesis
D015850:Interleukin-6; D016209:Interleukin-8; D019007:P-Selectin; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein; D013917:Thrombin