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Changes in factor VIII proteins after cardiopulmonary bypass in man suggest endothelial damage
D K Jones1, R Luddington, T W Higenbottam
1Department of Respiratory Physiology, Papworth Hospital, Cambridge, England.
Insights
Coronary artery bypass grafting can cause endothelial damage. Prostacyclin reduced platelet activation during surgery but did not prevent lung endothelial injury in patients undergoing cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Pulmonary Medicine
Background:
- Coronary artery bypass grafting (CABG) frequently involves cardiopulmonary bypass (CPB).
- CPB can induce systemic inflammation and endothelial activation.
- Understanding the impact of CPB on coagulation and endothelial markers is crucial.
Purpose of the Study:
- To investigate the changes in specific hemostatic and endothelial markers during and after CABG with CPB.
- To evaluate the effect of prostacyclin administration on platelet activation and endothelial markers.
- To assess potential pulmonary endothelial damage post-CPB.
Main Methods:
- Blood samples were collected from 16 patients undergoing CABG with CPB.
- Measurements included beta-thromboglobulin (BTG), alpha-1-antichymotrypsin (ACT), factor VIII procoagulant protein (VIII:C), von Willebrand factor antigen (vWF:Ag), and ristocetin co-factor (vWF:RiCoF).
- Prostacyclin was administered to 8 patients during CPB.
Main Results:
- Von Willebrand factor antigen (vWF:Ag) and ristocetin co-factor (vWF:RiCoF) levels increased during and after surgery, differing from ACT patterns.
- A disproportionate rise in vWF:Ag compared to vWF:RiCoF at 1 week suggested pulmonary endothelial damage.
- Prostacyclin reduced platelet activation (decreased BTG) and attenuated factor VIII consumption (VIII:C) but did not affect the vWF ratio indicative of pulmonary endothelial damage.
Conclusions:
- CPB during CABG is associated with alterations in hemostatic markers and potential pulmonary endothelial injury.
- Prostacyclin effectively mitigates platelet activation and factor VIII consumption during CPB.
- Prostacyclin does not appear to prevent the pulmonary endothelial damage indicated by the vWF marker ratio.
Abstract:
16 patients undergoing coronary artery bypass grafting using cardiopulmonary bypass (CPB) had blood samples taken at various times before, during and up to 1 week after surgery for estimation of beta-thromboglobulin (BTG), alpha-1-antichymotrypsin (ACT), factor VIII procoagulant protein (VIII:C), von Willebrand factor antigen (vWF:Ag) and ristocetin co-factor (vWF:RiCoF). vWF:Ag and vWF:RiCoF rose during and following surgery in a different manner to ACT. At 1 week there was a significantly disproportionate rise in vWF:Ag compared to vWF:RiCoF which suggested a degree of pulmonary endothelial damage. Prostacyclin, which was administered to 8 of the patients during CPB, reduced platelet activation as measured by a reduction in the release of BTG and also attenuated the consumption of VIII:C. It had no effect on pulmonary endothelial damage as measured by the ratio of vWF:Ag to vWF:RiCoF.