Related Experiment Video

Updated: Aug 9, 2026

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
09:12

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

Published on: March 27, 2018

Thrombin generation and activation of the thrombomodulin protein C system in open heart surgery depend on the

I Welters1, T Menges, M Ballesteros

  • 1Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.

Thrombosis Research
|October 23, 1998
PubMed

Insights

Coronary artery bypass grafting (CABG) patients show increased thrombin generation and endothelial damage markers during extracorporeal circulation (ECC) compared to aortic valve replacement (AVR) patients, suggesting a hypercoagulable state and potential thromboembolic risk.

Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Coagulation Science

Background:

  • Extracorporeal circulation (ECC) activates the coagulation system upon blood exposure to foreign surfaces.
  • Arteriosclerotic patients exhibit heightened thrombin activation, elevated fibrinogen, and reduced protein C levels.
  • Cardiac surgery necessitates understanding ECC's impact on hemostasis.

Purpose of the Study:

  • To investigate how different cardiac diseases influence ECC-induced thrombin generation.
  • To analyze the activation of the thrombomodulin-protein C system during ECC in cardiac surgery.
  • To compare hemostatic changes between coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) patients.

Main Methods:

  • Studied 24 patients undergoing elective CABG or AVR.
  • Collected blood samples pre-, during, and post-ECC, and postoperatively.
  • Measured plasma concentrations of thrombin-antithrombin III-complex (TAT), prothrombin fragment F1+2, thrombomodulin, protein C, protein S, and modified antithrombin (ATM) using ELISA and nephelometry.

Main Results:

  • Both CABG and AVR groups showed elevated TAT concentrations during ECC.
  • CABG patients exhibited higher prothrombin fragment F1+2 and ATM levels during cardiopulmonary bypass.
  • CABG patients had significantly increased plasma thrombomodulin and lower protein S levels, indicating endothelial damage and a hypercoagulable state.

Conclusions:

  • CABG patients display a more pronounced hypercoagulable state during ECC compared to AVR patients.
  • Elevated thrombomodulin and reduced protein S in CABG patients suggest significant endothelial activation.
  • These distinct hemostatic changes in CABG patients may contribute to perioperative thromboembolic events.

More Related Videos

In Vitro Microfluidic Disease Model to Study Whole Blood-Endothelial Interactions and Blood Clot Dynamics in Real-Time09:19

In Vitro Microfluidic Disease Model to Study Whole Blood-Endothelial Interactions and Blood Clot Dynamics in Real-Time

Published on: May 24, 2020

The Nijmegen Hemostasis Assay: Simultaneous Fluorogenic Measurement of Thrombin and Plasmin Generation in a Single Well08:01

The Nijmegen Hemostasis Assay: Simultaneous Fluorogenic Measurement of Thrombin and Plasmin Generation in a Single Well

Published on: February 27, 2026

Related Concept Videos

Pathophysiology of Cardiac Performance01:29

Pathophysiology of Cardiac Performance

Typical heart performance is influenced by heart rate, rhythm, myocardial contraction, and metabolism or blood flow. The cardiac muscle exhibits distinct electrophysiological features, including pacemaker activity and calcium channel control, which play a vital role in the heart's response to various drugs. The autonomic nervous system, comprising the sympathetic and parasympathetic branches, regulates heart rate. Sympathetic activation increases heart rate, while parasympathetic activation...
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
Extrinsic and Intrinsic Pathways of Hemostasis01:20

Extrinsic and Intrinsic Pathways of Hemostasis

Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
Clot Retraction and Fibrinolysis01:16

Clot Retraction and Fibrinolysis

After a fibrin clot is formed, the next step is clot retraction, a vital process facilitated by platelet contractile proteins, such as actin and myosin. These proteins pull the fibrin strands closer together and condense the clot. This action reduces the size of the clot, creating a smaller, denser structure that effectively seals off the damaged vessel. Clot retraction consolidates the clot and helps with wound healing by bringing the edges of the damaged blood vessel closer together.
Disorders of Hemostasis01:24

Disorders of Hemostasis

Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...