- 作者：Vladimir Radulovic ; Monica Hyllner ; Lisa Ternstr?m ; Martin Karlsson ; Anders Bylock ; Kenny M. Hansson ; Fariba Baghaei ; Anders Jeppsson
- 关键词：ACT ; Activated clotting time ; APTT ; Activated partial thromboplastin time ; BMI ; Body mass index ; CABG ; Coronary artery bypass grafting ; CAT ; Calibrated automated thrombogram ; CPB ; Cardiopulmonary bypass ; ECAT ; External quality control of diagnostic assays
- 刊名：Thrombosis Research
- 出版年：2012
- 出版时间：November, 2012
- 年：2012
- 卷：130
- 期：5
- 页码：769-774
- 全文大小：238 K
Introduction
Thrombin is a key component in the coagulation cascade, and impaired thrombin generation has been linked to increased bleeding after surgical procedures. The aim was to evaluate postoperative thrombin generation capacity in plasma after cardiac surgery, and its potential associations to activity of individual coagulation factors and heparin.Material and Methods
Forty-eight coronary artery bypass grafting patients were included in a prospective observational cohort study. Thrombin generation capacity was analysed in plasma with calibrated automated thrombogram with tissue factor as activator before (baseline), and 2 h and 24 h after surgery. In addition, plasma activity of coagulation factors II, V, VII, VIII, IX, X, XI, XIII, were determined. Heparin effect was assessed by anti-Xa activity, APTT and thrombin time.
Results
Thrombin generation was markedly reduced 2 h after surgery compared to baseline. Peak levels decreased with median 74 % (interquartile range 52-90), p < 0.001, and endogenous thrombin generation potential decreased with 65 % (43-86), p < 0.001. Postoperative changes in endogenous thrombin generation potential correlated inversely to changes in anti-Xa activity (r = ? 0.51, p = 0.010) and to changes in thrombin time (r = ? 0.51, p = 0.009), but there were no correlations to changes in individual coagulation factor activity.
Conclusions
A marked reduction in thrombin generation potential was observed in the early postoperative phase after cardiac surgery. The decrease was independent of reductions in individual coagulation factor activity but correlated to heparin effects. The results indicate that a sustained heparin effect contributes to the postoperative reduction in thrombin generation capacity.