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Published on: March 27, 2018
Long Period and High Level of D-Dimer after Coronary Artery Bypass Grafting Surgery
Zanxin Wang1, Zhaoyang Qian2, Jing Ren3
1Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital.
Insights
Elevated D-dimer levels persist for three months after off-pump coronary artery bypass grafting (OPCAB), indicating a prolonged hypercoagulable state. This finding is crucial for understanding post-surgical risks and managing patients effectively.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Clinical Chemistry
Background:
- Off-pump coronary artery bypass grafting (OPCAB) can lead to hyper-coagulation and graft thrombosis.
- D-dimer is a key indicator of coagulation activation.
- Limited data exists on D-dimer variations post-OPCAB in the Chinese population.
Purpose of the Study:
- To investigate the characteristics and clinical value of D-dimer levels following OPCAB.
- To assess the duration of abnormal coagulation markers after OPCAB.
Main Methods:
- Prospective study of 265 patients undergoing first-time OPCAB.
- D-dimer levels measured pre-surgery and at multiple time points up to 3 months post-surgery.
- One-year follow-up for clinical events, including recurrent angina.
Main Results:
- D-dimer levels rose post-OPCAB, peaking at 1 month and normalizing by 3 months.
- Higher 1-month D-dimer levels correlated with recurrent angina.
- Preoperative ejection fraction <50% and 1-month D-dimer >2915 μg/L predicted recurrent angina.
Conclusions:
- Patients exhibit elevated D-dimer for approximately 3 months after OPCAB, suggesting a sustained hypercoagulable and hyperfibrinolytic state.
- D-dimer monitoring may aid in identifying patients at risk for adverse outcomes like recurrent angina post-OPCAB.
Abstract:
Hyper-coagulation after off-pump coronary artery bypass grafting (OPCAB) is one of the main reasons for graft thrombosis. D-dimer is closely linked to the activation of coagulation. Few studies have reported the variation range and long-term abnormal coagulation after OPCAB in the Chinese population. Our study aimed to determine the characteristics and value of D-dimer after OPCAB.In this prospective study, 265 patients who underwent OPCAB for the first time were recruited from 2011 to 2012. The D-dimer level of the patients was tested before surgery and on the 1st, 4th, and 14th day, and 1st, 2nd, and 3rd month after surgery. Clinical data in the perioperative period and during the one-year follow-up period were recorded.D-dimer level increased from day 4 after OPCAB ([1321.9 ± 36.4] μg/L), peaked at 1 month ([2839.7 ± 101.4] μg/L), and decreased to the baseline ([370.3 ± 260.2] μg/L) 3 months after surgery. No death occurred, but 25 (10%) patients suffered recurrent angina in the one-year follow-up. They had significantly higher D-dimer level at one month after OPCAB than those of patients who did not suffer from angina. Preoperative ejection fraction <50% and D-dimer level >2915 μg/L at one month after surgery were significantly associated the recurrent angina.After OPCAB, patients have a higher level of D-dimer. And this lasts for a long period (about 3 months). It may reflect a certain degree of hypercoagulable and hyperfibrinolytic state after OPCAB.
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