Thrombophilic variables do not increase the generation or procoagulant activity of thrombin during cardiopulmonary bypass.
BACKGROUND
The generation of thrombin and its procoagulant activity are upregulated during cardiopulmonary bypass (CPB). Thrombophilia associates with increased basal thrombin generation and might therefore propagate thrombin generation during CPB. The objective of this study was to test whether preoperative thrombophilic variables associate with increased generation of thrombin or its procoagulant activity during and after CPB.


METHODS
Comprehensive thrombophilia screening was performed in patients (n = 100) before elective coronary artery bypass grafting (CABG) with CPB. Markers of thrombin generation (prothrombin fragment F1+2), its procoagulant activity (soluble fibrin complexes), and a marker of fibrin degradation (D-dimer) were measured serially at eight time points before, during, and after CABG.


RESULTS
Abnormal thrombophilia screening was common (44%). While patients with thrombophilic variables had higher preoperative prothrombin fragment F1+2 than others (median [interquartile range] 0.55 [0.34] vs 0.45 (0.21) nmol/L, p = 0.009) they did not have higher F1+2, D-dimer, or soluble fibrin complex levels during CPB or postoperatively than patients without thrombophilic variables.


CONCLUSIONS
Preoperative thrombophilic variables do not associate with perioperative thrombin generation or its procoagulant activity in patients undergoing CABG. Our results do not support routine thrombophilia screening before CABG.
Raivio
Peter
P
Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland. peter.raivio@hus.fi
Petäjä
Jari
J
Kuitunen
Anne
A
Lassila
Riitta
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010446:Peptide Fragments / Q000378:metabolism*; D011182:Postoperative Care; D011300:Preoperative Care / Q000379:methods; D011498:Protein Precursors / Q000378:metabolism*; D011516:Prothrombin / Q000378:metabolism*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013917:Thrombin / Q000378:metabolism; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis*; D016896:Treatment Outcome
D010446:Peptide Fragments; D011498:Protein Precursors; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D011516:Prothrombin; D013917:Thrombin