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Phosphorylcholine coating may limit thrombin formation during high-risk cardiac surgery: a randomized controlled
Federico Pappalardo1, Patrizia Della Valle, Giuseppe Crescenzi
1Department of Cardiovascular Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy. pappalardo.federico@hsr.it
The Annals of Thoracic Surgery
|February 21, 2006
Summary
Phosphorylcholine (Pc)-coated oxygenators may reduce intraoperative thrombin formation during high-risk open heart surgery. This coating helps preserve platelets, fibrinogen, and antithrombin levels, improving blood coagulation outcomes.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Hematology
Background:
- Cardiopulmonary bypass circuits activate platelets and coagulation factors.
- Phosphorylcholine (Pc) coating enhances surface biocompatibility.
- Tranexamic acid is often used in high-risk cardiac surgery.
Purpose of the Study:
- To evaluate the effect of a Pc-coated oxygenator on blood coagulation.
- To assess coagulation markers in patients undergoing high-risk open heart surgery.
- To compare Pc-coated versus standard oxygenators in conjunction with tranexamic acid.
Main Methods:
- Randomized trial of 39 patients undergoing reoperative valve or combined procedures.
- Comparison between Pc-coated (Pc group) and standard oxygenators (control group).
- Measurement of platelet count, soluble CD40 ligand, fibrinogen, antithrombin, D-Dimer, prothrombin fragment 1.2 (F1.2), and free plasma hemoglobin.
Main Results:
- F1.2 levels, indicating thrombin formation, were higher in the control group at aortic unclamping (p=0.02).
- Pc-coated oxygenators showed a positive correlation between F1.2 and aortic cross-clamp times.
- No significant differences in postoperative bleeding, blood product use, or clinical outcomes between groups.
Conclusions:
- Pc-coated oxygenators may reduce intraoperative thrombin formation in high-risk cardiac surgery patients on tranexamic acid.
- This reduction may mitigate the consumption of platelets, fibrinogen, and antithrombin.
- Further research may explore the clinical benefits of Pc-coated oxygenators in specific patient populations.
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