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Platelet function after coronary artery bypass grafting: is there a procoagulant activity after off-pump compared
1Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Denmark. chm@stud.ku.dk
Insights
Off-pump coronary artery bypass (OPCAB) surgery leads to increased platelet activation in the early postoperative period compared to on-pump coronary artery bypass grafting (CABG). On-pump CABG temporarily impairs platelet function, which recovers within 24 hours.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Platelet Physiology
Background:
- Off-pump coronary artery bypass (OPCAB) surgery may offer better hemostasis than on-pump coronary artery bypass grafting (CABG).
- The impact of OPCAB on platelet procoagulant activity requires further investigation.
Purpose of the Study:
- To investigate whether improved hemostasis after OPCAB is associated with increased platelet procoagulant activity.
- To compare platelet function postoperatively between OPCAB and on-pump CABG.
Main Methods:
- Prospective study of 30 patients (15 OPCAB, 15 on-pump CABG).
- Platelet function assessed using a bedside whole blood clotting test at four time points within 24 hours: preoperatively, postoperatively, 4 hours, and 1 day after surgery.
Main Results:
- Platelet-activating-factor-induced platelet aggregation significantly increased post-OPCAB (p < 0.01).
- Half of the on-pump CABG patients regained normal platelet aggregation within 1 day, while platelet aggregation was reduced immediately after surgery.
- Post-OPCAB, two patients did not reach preoperative values within 1 day, and four had more than a twofold increase.
Conclusions:
- Platelets exhibit enhanced activation in the early postoperative period following OPCAB.
- Coronary artery bypass grafting (CABG) with cardiopulmonary bypass results in temporary platelet dysfunction, which resolves within the first postoperative day.
Objective:
After off-pump coronary artery bypass (OPCAB) haemostasis might be better preserved compared with on-pump coronary artery bypass grafting (CABG). The aim of this study was to investigate whether this possibly better preserved haemostasis results in a procoagulant activity of the platelets.
Design:
Thirty patients were studied prospectively, 15 undergoing on-pump CABG and 15 undergoing OPCAB. Platelet function was evaluated four times within the first 24 h: preoperatively, postoperatively, 4 h and 1 day after surgery with a bedside whole blood clotting test.
Results:
A significant increase of platelet-activating-factor-induced platelet aggregation was observed postoperatively after OPCAB (p < 0.01). Only two patients did not reach preoperative values within 1 day postoperatively and four patients had a more than twofold increase. Platelet aggregation immediately after on-pump CABG was reduced to near half of preoperative values, but within 1 day postoperatively normal platelet aggregation was regained in half of the patients.
Conclusion:
This study has mainly indicated that platelets after OPCAB were more easily activated in the early postoperative period. After CABG with cardiopulmonary bypass we found a temporary platelet dysfunction which seemed to be overcome within the first postoperative day.