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Endothelial-related coagulation in cardiac surgery
J Boldt1, E Schindler, C Knothe
1Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Insights
Advanced age and complex cardiac surgery increase thrombomodulin levels, impacting the thrombomodulin-protein C system. Protein C levels decrease in older patients and after complex procedures.
Area of Science:
- Cardiovascular Science
- Hematology
- Vascular Biology
Background:
- The endothelium plays a crucial role in regulating intravascular coagulation.
- Thrombomodulin, an anticoagulant, is expressed by endothelial cells.
- The impact of aging and surgical complexity on this system is not fully understood.
Purpose of the Study:
- To investigate the influence of age and surgical complexity on the thrombomodulin-protein C system in cardiac surgery patients.
- To compare thrombomodulin, protein C, and protein S levels in different patient groups and at various time points.
Main Methods:
- Prospective study of 80 cardiac surgery patients, divided into age groups (>70 vs. <50 years) and complexity groups (simple vs. complex surgery).
- Measurement of thrombomodulin, protein C, and free protein S plasma concentrations using ELISA.
- Serial measurements were taken at baseline, during/after cardiopulmonary bypass, end of surgery, 5 hours post-CPB, and on day 1 post-operation.
Main Results:
- Patients >70 years and those undergoing complex surgery experienced greater blood loss and required more blood products.
- Baseline thrombomodulin levels were elevated in patients undergoing complex surgery.
- Thrombomodulin levels significantly increased post-bypass and post-operation in older patients and those with complex procedures (P < 0.05).
- Protein C and S levels showed similar changes across groups, except for a reduction in protein C on day 1 post-operation in older patients and those with complex surgery.
Conclusions:
- Age >70 years and complex cardiac surgery are associated with increased thrombomodulin levels.
- These factors may also lead to a decrease in protein C levels post-operatively.
- The thrombomodulin-protein C system is significantly affected by age and surgical complexity in cardiac surgery patients.
Abstract:
The endothelium appears to play an important role in the regulation of intravascular coagulation. Thrombomodulin is one of the anticoagulant substances that is expressed by endothelial cells. The influence of age and illness on the thrombomodulin-protein C system was studied prospectively in 80 cardiac surgery patients. Patients > 70 yr old (n = 20) were compared with patients < 50 yr (n = 20) (group I), and patients undergoing a simple cardiac procedure (n = 20) were compared with patients scheduled for complex surgery (n = 20) (group II). Thrombomodulin (normal < 40 ng ml-1), protein C and (free) protein S plasma concentrations were measured by enzyme-linked immunosorbent assays (ELISA) after induction of anaesthesia (baseline values), during and after cardiopulmonary bypass (CPB), at the end of surgery, 5 h after CPB and on the first day after operation. Blood loss and use of homologous blood and blood products were significantly greater in patients > 70 yr and in those undergoing complex surgery. At baseline, thrombomodulin concentration was increased in patients undergoing complex surgery (mean 52 (sd 9) ng ml-1). After bypass and after operation, thrombomodulin increased most in patients > 70 yr (from 40 (8) to 78 (10) ng ml-1) and in those patients who underwent complex cardiac operations (from 52 (8) to 79 (10 ng ml-1) (P < 0.05). Changes in protein C and protein S concentrations were similar in all groups. On the first day after operation only, protein C concentrations were reduced in patients > 70 yr and in patients who underwent complex cardiac surgery.(ABSTRACT TRUNCATED AT 250 WORDS)