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Published on: September 15, 2023
Thrombin generation during reperfusion after coronary artery bypass surgery associates with postoperative myocardial
P Raivio1, A Kuitunen, R Suojaranta-Ylinen
1Department of Cardiothoracic Surgery, Helsinki University Central Hospital, FIN-00029 HUS, Helsinki, Finland. peter.raivio@hus.fi
Insights
Thrombin generation during reperfusion after coronary artery bypass grafting (CABG) increases, correlating with myocardial damage and pulmonary vascular resistance. This highlights thrombin
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Myocardial Protection
Background:
- Cardiopulmonary bypass and CABG trigger significant thrombin generation and fibrinolysis.
- Thrombin's role in myocardial damage post-CABG remains unclear, despite its known contribution to ischemia-reperfusion injury in animal models.
Purpose of the Study:
- To quantify thrombin generation and fibrin turnover during reperfusion following CABG.
- To assess the association between these markers and postoperative hemodynamic changes and myocardial damage.
Main Methods:
- Prospective enrollment of 100 patients undergoing elective, on-pump CABG.
- Measurement of plasma prothrombin fragment F(1+2) and D-dimer preoperatively and at multiple time points postoperatively.
- Assessed myocardial damage using creatine kinase MB fraction (Ck-Mbm) and troponin T (TnT) on postoperative day 1.
Main Results:
- Reperfusion led to increased thrombin generation and fibrin turnover, even with full heparinization.
- Early reperfusion F(1+2) levels correlated with postoperative pulmonary vascular resistance index.
- Postoperative F(1+2) levels were significantly associated with Ck-Mbm and TnT levels, indicating myocardial damage (r = 0.40-0.44, P < 0.001).
- Higher F(1+2) levels during reperfusion were observed in patients with myocardial damage (P < 0.002).
- Logistic regression confirmed F(1+2) during reperfusion as an independent predictor of postoperative myocardial damage (OR 2.5-4.4).
Conclusions:
- Coronary artery bypass grafting reperfusion triggers a surge in thrombin generation and fibrin turnover, despite anticoagulation.
- Thrombin generation during reperfusion is linked to increased pulmonary vascular resistance and myocardial damage after CABG.
Background:
Cardiopulmonary bypass and coronary artery bypass grafting (CABG) result in significant thrombin generation and activation of fibrinolysis. Thrombin contributes to myocardial ischemia-reperfusion injury in animal studies, but the role of thrombin in myocardial damage after CABG is unknown.
Objectives:
We measured thrombin generation and fibrin turnover during reperfusion after CABG to evaluate their associations with postoperative hemodynamic changes and myocardial damage.
Methods:
One hundred patients undergoing primary, elective, on-pump CABG were prospectively enrolled. Plasma prothrombin fragment F(1+2) and D-dimer were measured preoperatively and at seven time points thereafter. Mass of the Mb fraction of creatine kinase (Ck-Mbm) and troponin T (TnT) were measured on the first postoperative day.
Results:
Reperfusion induced an escalation of thrombin generation and fibrin turnover despite full heparinization. F(1+2) during early reperfusion associated with postoperative pulmonary vascular resistance index. F(1+2) at 6 h after protamine administration correlated with Ck-Mbm (r = 0.40, P < 0.001) and TnT (r = 0.44, P < 0.001) at 18 h postoperatively. Patients with evidence of myocardial damage (highest quintiles of plasma Ck-Mbm and TnT) had significantly higher F(1+2) during reperfusion than others (P < 0.002). Logistic regression models identified F(1+2) during reperfusion to independently associate with postoperative myocardial damage (odds ratios 2.5-4.4, 95% confidence intervals 1.04-15.7).
Conclusions:
Reperfusion caused a burst in thrombin generation and fibrin turnover despite generous heparinization. Thrombin generation during reperfusion after CABG associated with pulmonary vascular resistance and postoperative myocardial damage.
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