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Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Fibrinolysis in coronary artery surgery: detection by thromboelastography
Tomas Vanek1, Martin Jares, Jana Snircova
1Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Czech Republic. vanek@fnkv.cz
Insights
Conventional coronary artery bypass grafting showed increased fibrinolysis during cardiopulmonary bypass compared to off-pump surgery or modified bypass. Thromboelastographic signs of fibrinolysis were specific to conventional bypass.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) involves cardiopulmonary bypass (CPB), which can affect hemostasis.
- Fibrinolysis, the breakdown of blood clots, is a critical aspect of hemostasis that may be altered during CPB.
Purpose of the Study:
- To compare the impact of conventional CABG, off-pump CABG, and modified CPB on fibrinolysis using thromboelastography.
- To investigate the presence and extent of fibrinolysis during different surgical techniques.
Main Methods:
- Randomized controlled trial with 65 patients undergoing coronary surgery.
- Three groups: conventional CABG (Group A), off-pump CABG (Group B), and modified CPB with rheoparin coating and no cardiotomy blood re-infusion (Group C).
- Thromboelastography (TEG) was used to assess lysis on set time at various time points.
Main Results:
- Significant inter-group differences in lysis on set time were observed at 60 and 150 minutes post-bypass (P=0.003 and P<0.001).
- Group A (conventional CABG) exhibited significantly lower lysis on set time values compared to Groups B and C.
- Thromboelastographic signs of fibrinolysis were detectable during CPB in Group A but not in Groups B or C.
Conclusions:
- Conventional CABG with CPB is associated with detectable signs of fibrinolysis.
- Off-pump surgery and modified CPB techniques appear to mitigate the pro-fibrinolytic effects observed with conventional CPB.
- TEG is a valuable tool for monitoring hemostatic changes, including fibrinolysis, during cardiac surgery.
Abstract:
Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of assessment (P=0.003) and at 150 min of assessment (P<0.001), the mean values of these parameters were significantly lower in group A as compared with both groups B and C, which were statistically indistinguishable. Lysis on set time on the completion of peripheral bypass anastomoses <50% was detected in 12 patients (52.2%) originating from group A. At the other sampling times (preoperatively, 15 min after sternotomy, at the end of the procedures, and 24 h later) thromboelastographic parameters were similar in all groups. In group A no significant correlations between lysis on set time, postoperative blood loss and D-dimer levels were found. Based on our results, thromboelastographic signs of fibrinolysis were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C.
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