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Biphasic pro-thrombotic and inflammatory responses after coronary artery bypass surgery

N Li1, R Astudillo, T Ivert

  • 1Department of Medicine, Division of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden. Nail.Li@ks.se

Journal of Thrombosis and Haemostasis : JTH
|July 23, 2003
PubMed

Insights

Coronary artery bypass grafting (CABG) triggers significant pro-thrombotic and inflammatory responses, peaking again one week post-surgery. These findings suggest prolonged antithrombotic and anti-inflammatory treatments may be beneficial after CABG.

Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Thrombosis Research

Background:

  • Early graft failure following coronary artery bypass grafting (CABG) is frequently linked to thrombosis and inflammation within the grafted vessels.
  • The precise temporal dynamics and interrelationships of pro-thrombotic and inflammatory responses after CABG surgery remain incompletely understood.

Purpose of the Study:

  • To investigate the time course and magnitude of pro-thrombotic and inflammatory responses after CABG.
  • To examine the relationships between cellular and plasma markers of activation and response.

Main Methods:

  • Whole blood flow cytometry was used to monitor cellular markers of platelet and leukocyte activation.
  • Plasma markers of pro-thrombotic (thrombin generation) and inflammatory (cytokine release) responses were analyzed via immunoassays.
  • Fifteen patients undergoing CABG were assessed at multiple time points: pre-surgery, 1 hour, 1 day, 7 days, and 3 months post-surgery.

Main Results:

  • CABG induced immediate increases in circulating activated platelets, leukocytes, platelet-leukocyte aggregates (PLAs), thrombin generation (F1+2), and cytokines (TNF-α, IL-8, IL-10).
  • These alterations persisted for the first week, with a secondary peak in activated platelets, PLAs, TNF-α, and F1+2 observed on day 7.
  • While initially suppressed, platelet and PLA responsiveness to in vitro stimulation was significantly enhanced one week post-CABG. Elevated levels of soluble P-selectin, F1+2, IL-10, and monocyte CD11b expression persisted at 3 months.

Conclusions:

  • CABG provokes substantial pro-thrombotic and inflammatory responses that endure for at least one week, characterized by a biphasic pattern.
  • The findings highlight a critical window of heightened platelet activation and reactivity one week after surgery.
  • Consideration of intensified and extended antithrombotic and anti-inflammatory therapies post-CABG is warranted to mitigate graft failure risks.

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