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Thrombin-antithrombin complexes and prothrombin fragment 1+2 in aorto-coronary bypass surgery: relation to graft
J Rifón1, J A Páramo, F Prósper
1Hematology Service, School of Medicine, University of Navarra Pamplona, Spain.
Insights
Elevated thrombin-antithrombin (TAT) complexes and prothrombin fragment 1+2 (F 1+2) indicate clotting activation after bypass surgery. Preoperative TAT levels may predict early graft occlusion in these patients.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Biomarker Research
Background:
- Graft thrombotic occlusion is a frequent complication following aorto-coronary bypass surgery.
- Clotting system activation is implicated in the pathogenesis of graft occlusion.
Purpose of the Study:
- To investigate plasma concentrations of hemostatic markers, thrombin-antithrombin (TAT) complexes and prothrombin fragment 1+2 (F 1+2).
- To assess the relationship between these markers and early graft occlusion after aorto-coronary bypass surgery.
Main Methods:
- Plasma TAT complexes and F 1+2 were measured in 100 patients undergoing revascularization.
- 81 patients underwent shunt angiography to assess graft patency.
- Hemostatic markers were analyzed preoperatively and postoperatively on days 1 and 5.
Main Results:
- A significant increase in TAT complexes and F 1+2 was observed immediately after surgery and on postoperative days 1 and 5 (p < 0.001).
- No direct correlation was found between postoperative marker levels and graft occlusion.
- Preoperative TAT concentrations were significantly higher in patients who developed graft occlusion (p < 0.01).
Conclusions:
- Aorto-coronary bypass surgery is associated with marked activation of the clotting system.
- Elevated preoperative TAT levels serve as a potential predictive marker for early graft occlusion.
Abstract:
Graft thrombotic occlusion is a common complication in patients undergoing aorto-coronary bypass surgery. Clotting activation seems to contribute to the thrombotic event. We have determined the plasma concentrations of two hemostatic markers, thrombin-antithrombin (TAT) complexes and prothrombin fragment 1+2 (F 1+2) in 100 patients undergoing revascularization procedures of whom 81 underwent shunt angiography. Angiographically proven graft occlusion was present in 19 patients (23.5%). A significant increase of both parameters was observed immediately after surgery and on postoperative days 1 and 5 (p < 0.001), although a relationship to graft occlusion could not be demonstrated. However, the preoperative TAT concentration was higher in patients developing graft occlusion (p < 0.01). We conclude that there is a marked clotting activation in patients undergoing aorto-coronary bypass surgery, as demonstrated by elevated TAT and F 1+2 concentrations. Preoperative TAT values can be good markers of early graft occlusion.