Closed cardiopulmonary bypass circuits suppress thrombin generation during coronary artery bypass grafting.
Thrombin generation is considered unavoidable during cardiac surgery using cardiopulmonary bypass (CPB). We compared the effects of open and closed circuits on coagulation and fibrinolysis under identical conditions of priming volume, heparin-coating, and anticoagulation and transfusion protocols. Thirty coronary surgery patients were randomized to surgery using open circuits with open reservoirs and cardiotomy suction (open group, n=15) or closed circuits without either (closed group, n=15). In the closed group, a cell-saving device was used instead of cardiotomy suction. Blood samples were collected at eight time points from before the operation to the first postoperative morning. Thrombin-antithrombin III (TAT), fibrinogen degradation products, and D-dimer were not elevated during CPB in the closed group, but were significantly increased in the open group (P<0.0001 for all markers). The peak TAT value at the termination of CPB in the open group was significantly correlated with CPB time (r(2)=0.879, P=0.037) and the simultaneous peak D-dimer value (r(2)=0.640, P=0.040). In conclusion, the use of closed circuits maximally suppressed thrombin generation and coagulofibrinolytic activation during coronary artery bypass grafting. The respective contribution of open reservoirs and cardiotomy suction to the perioperative thrombin generation remains to be elucidated.
Nakahira
Atsushi
A
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-0051, Japan. osushi123@med.osaka-cu.ac.jp
Sasaki
Yasuyuki
Y
Hirai
Hidekazu
H
Fukui
Toshihiro
T
Matsuo
Mitsunori
M
Takahashi
Yosuke
Y
Kotani
Shinsuke
S
Suehiro
Shigefumi
S
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D000990:Antithrombin III; D001777:Blood Coagulation; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D006400:Hematocrit; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010447:Peptide Hydrolases / Q000097:blood; D010976:Platelet Count; D011446:Prospective Studies; D013396:Suction; D013917:Thrombin / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases; D013917:Thrombin