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Enhanced thrombin generation after cardiopulmonary bypass surgery
Susanne Lison1, Wulf Dietrich, Siegmund Braun
1Working Group of Perioperative Hemostasis, Ludwig Maximilians Universitaet, Munich, Germany.
Anesthesia and Analgesia
|December 4, 2010
Summary
Post-cardiac surgery, thrombin generation and capacity increase, indicating a procoagulative state. Warfarin treatment in aortic valve replacement patients significantly reduced this thrombin generation capacity.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Coagulation Medicine
Background:
- Thrombin generation is crucial in hemostasis, with limited understanding of postoperative activation.
- Thrombin generation assays, including the thrombin dynamics test (TDT), assess hypercoagulability.
- Cardiac surgery patients may experience altered hemostatic activation postoperatively.
Purpose of the Study:
- To investigate changes in thrombin generation and capacity after cardiac surgery.
- To evaluate the kinetics of thrombin formation using the thrombin dynamics test (TDT).
- To assess the impact of warfarin on postoperative thrombin generation in specific patient groups.
Main Methods:
- Prospective enrollment of 220 patients undergoing coronary artery bypass grafting or aortic valve replacement (AVR).
- Assessed prothrombin fragment (F(1+2)), TDT, d-dimer, and troponin T preoperatively and at multiple postoperative time points.
- Warfarin administered post-AVR starting on postoperative day 2; TDT on postoperative day 1 was the primary endpoint.
Main Results:
- Prothrombin fragment (F(1+2)) remained elevated until postoperative day 5 in all patients.
- Thrombin dynamics test (TDT) was significantly elevated on postoperative day 1 compared to baseline.
- Coronary artery bypass graft patients showed sustained TDT elevation, while warfarin-treated AVR patients had reduced TDT on postoperative days 3 and 5.
Conclusions:
- Cardiac surgery leads to persistent thrombin generation and high thrombin-generating capacity, suggesting a postoperative procoagulative state.
- This procoagulative state may increase the risk of thromboembolic complications.
- Warfarin treatment effectively reduced thrombin-generating capacity in AVR patients.
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