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J Thorac Cardiovasc Surg. 2014 Aug;148(2):536-43. doi: 10.1016/j.jtcvs.2013.10.028. Epub 2013 Nov 23.

Natural history of hypercoagulability in patients undergoing coronary revascularization and effect of preoperative myocardial infarction.

Author information

1
Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, The Baird Institute, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; ANZAC Research Institute, Sydney, Australia. Electronic address: jjbedelman@gmail.com.
2
ANZAC Research Institute, Sydney, Australia.
3
Sydney Medical School, University of Sydney, Sydney, Australia; ANZAC Research Institute, Sydney, Australia; Concord Repatriation General Hospital, Sydney, Australia.
4
Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, The Baird Institute, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
5
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
6
Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, The Baird Institute, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.

Abstract

OBJECTIVES:

The balance between hyper- and hypocoagulable states is critical after coronary artery surgery both with (coronary artery bypass grafting [CABG]) and without (off-pump coronary artery bypass [OPCAB]) cardiopulmonary bypass to prevent thrombotic or bleeding complications. We aimed to quantify novel parameters of coagulation, fibrinolysis, and overall hemostasis ≤6 months after CABG and OPCAB and to determine the influences on these parameters.

METHODS:

A total of 63 patients (30 CABG, 33 OPCAB) had blood collected before and at various points ≤6 months after surgery. Fibrin and fibrinolysis time curves were generated by measuring the absorption of 405 nm each minute for 100 minutes after the addition of tissue factor and tissue plasminogen activator to cell-free plasma. The parameters were compared with those from a group of healthy controls.

RESULTS:

The patients' preoperative prothrombotic assay parameters were compared with those from healthy controls. Both CABG and OPCAB patients were hypercoagulable until at least day 10 after surgery, with elevation of fibrin generation (CABG, peak day 3, +28.9%; OPCAB, peak day 1, +16.3% vs preoperative baseline) and impairment of fibrinolysis capacity (CABG, day 1, -58.4%; OPCAB, day 1, -22.6%). Surgical revascularization resulted in resolution of preoperative hypercoagulability by 6 months postoperatively. Patients with preoperative myocardial infarction (MI) had prolonged hypercoagulability after surgery that was most exaggerated after CABG (overall hemostatic potential day 5, no MI, +64.1% vs with MI, +128.9% compared with baseline; P = .013).

CONCLUSIONS:

Patients will be vulnerable to thrombotic events for ≤6 weeks after coronary surgery yet will have resolution of hypercoagulability by 6 months. Preoperative factors, such as MI, could require individualized management of thrombosis prophylaxis in the postoperative period.

PMID:
24280714
DOI:
10.1016/j.jtcvs.2013.10.028
[Indexed for MEDLINE]
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