title: Increased preoperative thrombin generation and low protein S level associated with unfavorable postoperative hemodynamics after coronary artery bypass grafting.
abstract: In a previous study, preoperative levels of activated protein C (APC) were associated with unfavorable postoperative hemodynamics after coronary artery bypass grafting (CABG). Protein C is activated by thrombin. Protein S, the cofactor of activated protein C, has activated protein C-independent anticoagulant activity and cytoprotective effects. Therefore, the objective of this study was to test whether preoperative, baseline levels of either thrombin or protein S were associated with hemodynamic performance or markers of myocardial damage after CABG. One hundred patients undergoing elective on-pump CABG were prospectively studied. Prothrombin fragment F1+2 (a marker of thrombin generation) and free protein S were measured preoperatively and cardiac index, systemic vascular resistance index (SVRI), and pulmonary vascular resistance index (PVRI) were measured serially thereafter at fixed time points. Cardiac biomarkers CK-MBm and TnT were measured postoperatively. There was an inverse correlation between preoperative F1+2 and free protein S levels (r= -0.30, p=0.003). High preoperative F1+2 and low preoperative protein S levels were associated with a less favorable hemodynamic profile postoperatively. Patients with F1+2 in the highest decile (≥0.85 nmol/l) and patients with preoperative protein S in the lowest decile (≤63%) had lower CI values, and higher pulmonary and systemic vascular resistance index values postoperatively than comparison patients. Preoperative F1+2 or protein S did not correlate with postoperative cardiac biomarker levels. Baseline activation of coagulation and the balance between pro-coagulant and anti-coagulant factors preoperatively might have implications for postoperative hemodynamic recovery after CABG.
authors.affiliation: Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland. peter.raivio@hus.fi
authors.forename: Peter M
authors.initials: PM
authors.lastname: Raivio
authors.forename: Riitta
authors.initials: R
authors.lastname: Lassila
authors.forename: Anne H
authors.initials: AH
authors.lastname: Kuitunen
authors.forename: Heidi
authors.initials: H
authors.lastname: Eriksson
authors.forename: Raili T
authors.initials: RT
authors.lastname: Suojaranta-Ylinen
authors.forename: Jari
authors.initials: J
authors.lastname: Petäjä
mesh_terms: D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D011184:Postoperative Period; D057234:Preoperative Period; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000378:metabolism*; D013917:Thrombin / Q000378:metabolism*
chemical_list: D011486:Protein C; D017293:Protein S; D013917:Thrombin