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Changes in haemostasis and proteins of the acute phase following cardiac surgery
J Kvasnicka1, Z Krska, I Vacková
1Department of Clinical Haematology, First Medical Faculty, Charles University, Prague.
Insights
Cardiac surgery alters blood clotting, increasing thrombophilia risk post-operation. Changes in platelets, fibrinogen, and fibrinolysis are observed, influenced by extracorporeal circulation and patient atherosclerosis.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Cardiac surgery, particularly with extracorporeal circulation (ECC), can significantly impact patient hemostasis.
- Understanding postoperative hemostatic changes is crucial for managing thrombotic and bleeding risks.
Purpose of the Study:
- To investigate the dynamic changes in hemostasis following heart valve prostheses (PHVS) and coronary artery bypass grafting (CABG) surgery.
- To compare hemostatic alterations between PHVS and CABG patients under different antithrombotic treatments.
Main Methods:
- Prospective study involving 12 patients after PHVS and 19 after CABG.
- Hemostasis parameters were monitored on days 1, 3, 6, 10, and 21 post-operation.
- Patients received either anticoagulants (PHVS) or thrombocyte inhibitors (CABG) as antithrombotic therapy.
Main Results:
- Both groups showed a decline in thrombocytes on day 1, followed by an increase after day 10.
- Fibrinogen and acute-phase proteins (alpha-1-antitrypsin, orosomucoid, ceruloplasmin) increased from day 6, while transferrin decreased.
- Fibrinolysis activators declined on days 3 and 6 post-operation, suggesting increased thrombophilia risk.
- CABG patients exhibited a more pronounced thrombocyte drop on day 1, higher fibrinogen on day 6, and reduced fibrinolytic activity on day 10 compared to PHVS patients.
Conclusions:
- Postoperative hemostatic changes following cardiac surgery indicate an elevated risk of thrombophilia, potentially linked to interleukin-1 release and surgical stress.
- Observed differences between CABG and PHVS patients may be attributed to underlying atherosclerosis rather than antithrombotic treatments.
Abstract:
After cardiac surgery performed with extracorporeal circulation (ECC) involving heart valve prostheses (PHVS, n 12) and after a bypass of the coronary arteries by a venous graft (CABG, n 19), the authors investigated the dynamics of changes of haemostasis on the 1st, 3rd, 6th, 10th and 21st day after operation. As anti-thrombotic treatment after PHVS anticoagulants were used, after CABG thrombocyte inhibitors. On the 1st day after operation in both groups thrombocytes decline, while after the 10th day their numbers increase. From the 6th day there is in both groups a rise of fibrinogen and other proteins of the acute phase (alpha-1-antitrypsin, orosomucoid and ceruloplasmin, while there was a drop of transferrin. On the 3rd and 6th day after operation fibrinolysis activators decline (euglobulin fibrinolysis). These findings suggest an increased risk of thrombophilia during the postoperative period and are probably associated with the release of interleukin-1 after Ecc and the stress of cardiac surgery. In patients with CABG on the 1st day a major drop of thrombocytes occurs, on the 6th day an elevated fibrinogen value was recorded and on the 10th day a reduced fibrinolytic activity, as compared with patients with PHVS. These changes will be, however, associated rather with a greater development of general atherosclerosis in patients with CABG, which leads to a further alteration of haemostasis, rather than with the applied antithrombotic treatment.