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Published on: November 19, 2019
Haemostatic function in patients undergoing coronary artery bypass grafting: peroperative perturbations and relations
E Moor1, M Blombäck, A Silveira
1Departments of Cardiology, King Gustaf V Research Institute, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden.
Insights
Elevated plasminogen activator inhibitor-1 activity post-surgery may predict early saphenous vein graft occlusion in coronary artery bypass grafting patients. This finding suggests a potential link between hemostatic function and graft failure.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Vascular Biology
Background:
- Vein graft failure is a significant complication following coronary artery bypass grafting (CABG).
- Early graft occlusion is often attributed to thrombosis, while later failure involves intimal hyperplasia and atherosclerosis.
- Understanding factors predisposing to early graft occlusion is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate whether alterations in hemostatic function predict early saphenous vein graft occlusion after CABG.
- To identify specific hemostatic factors associated with graft failure within three months of surgery.
Main Methods:
- A pilot study involving 100 men undergoing elective CABG for stable angina pectoris.
- Pre- and postoperative measurements of hemostatic factors and inhibitors on days 1, 3, and 6.
- Assessment of vein graft occlusion via angiography at 3 months post-surgery.
Main Results:
- Vein graft occlusion occurred in 23% of the patients within three months.
- A significantly higher percentage increase in plasma plasminogen activator inhibitor-1 (PAI-1) activity on postoperative day 1 was observed in patients with graft occlusion (p<0.05).
- No other postoperative hemostatic measurements reliably predicted early vein graft closure.
Conclusions:
- A perturbed plasma PAI-1 response following CABG may be a contributing factor to early vein graft occlusion.
- PAI-1 response warrants further investigation as a potential predictor of graft failure, alongside vessel-specific factors.
Abstract:
Vein graft failure remains a major problem after coronary artery bypass grafting. Occlusion in the first weeks usually is caused by thrombosis, whereas intimal hyperplasia and eventually atherosclerotic changes with superimposed thrombus formation underlie subsequent closure. The present investigation was conducted as a pilot study to examine whether perturbations of haemostatic function predispose to early saphenous vein graft occlusion after coronary artery bypass grafting. Pre- and postoperative determinations (performed on the first, third, and sixth postoperative days) of haemostatic factors and inhibitors were related to the presence of graft occlusion assessed by angiography at 3 months after surgery in 100 men undergoing elective coronary artery bypass grafting for stable angina pectoris. Occlusion of one or more vein grafts within three months of surgery occurred in 23 of the 100 patients examined. The percentage increase in plasma plasminogen activator inhibitor-1 activity on the first postoperative day was significantly higher in patients who subsequently were found to have vein graft occlusion (p<0.05). Otherwise no postoperative haemostatic measurements were found to predict early vein graft closure. A perturbed plasma plasminogen activator inhibitor-1 response to coronary artery bypass grafting tentatively could be added to the vessel-specific factors that remain the main determinants of early vein graft closure.
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