Activation of Coagulation and Fibrinolysis During Coronary Artery Bypass Grafting: A Comparison Between On-Pump and Off-Pump Techniques

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• 作者：Shreosee Roy (1) (2)
  Kaushik Saha (1) (3)
  Krishnendu Mukherjee (4)
  Santanu Dutta (5)
  Debasis Mukhopadhyay (1)
  Indranil Das (1)
  Gargi Raychaudhuri (6)
  
• 关键词：Coronary artery bypass grafting (CABG) ; On ; pump ; Off ; pump ; Fibrinolysis ; Coagulation ; Hemostasis ; Cardiopulmonary bypass (CPB) ; Off ; pump CABG (OPCAB)
• 刊名：Indian Journal of Hematology and Blood Transfusion
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：30
• 期：4
• 页码：333-341
• 全文大小：898 KB
• 参考文献：1. van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, van Boven WJ, Borst C, Buskens E, Grobbee DE, Robles De Medina EO, de Jaegere PP, Octopus Study Group (2001) Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation 104:1761-766 CrossRef
  2. Angelini GD, Taylor FC, Reeves BC, Ascione R (2002) Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359:1194-199 CrossRef
  3. Edmunds LH Jr (1998) Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 66(5 Suppl):S12–S16 CrossRef
  4. Parolari A, Colli S, Mussoni L, Eligini S, Naliato M, Wang X, Gandini S, Tremoli E, Biglioli P, Alamanni F (2003) Coagulation and fibrinolytic markers in a two-month follow-up of coronary bypass surgery. J Thorac Cardiovasc Surg 125:336-43 CrossRef
  5. Mannucci L, Gerometta PS, Mussoni L, Antona C, Parolari A, Salvi L, Biglioli P, Tremoli E (1995) One month follow-up of haemostatic variables in patients undergoing aortocoronary bypass surgery: effect of aprotinin. Thromb Haemost 73:356-61
  6. Moor E, Hamsten A, Blomback M, Herzfeld I, Wiman B, Ryden L (1994) Hemostatic factors and inhibitors and coronary artery bypass grafting: preoperative alterations and relation to graft occlusion. Thromb Haemost 72:335-42
  7. Li N, Astudillo R, Ivert T, Hjemdahl P (2003) Biphasic pro-thrombotic and inflammatory responses after coronary artery bypass surgery. J Thromb Haemost 1:470-76 CrossRef
  8. Parolari A, Alamanni F, Cannata A, Naliato M, Bonati L, Rubini P et al (2003) OPCAB versus CABG: meta-analysis of currently available randomized trials. Ann Thorac Surg 76:37-0 CrossRef
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  10. Biglioli P, Cannata A, Alamanni F, Naliato M, Porqueddu M, Zanobini M, Tremoli E, Parolari A (2003) Biological effects of off-pump versus on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress. Eur J Cardiothorac Surg 24:260-69 CrossRef
  11. Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J, Gardner TJ, Gott JP, Herrmann HC, Marlow RA, Nugent W, O’Connor GT, Orszulak TA, Rieselbach RE, Winters WL, Yusuf S, Gibbons RJ, Alpert JS, Garson A Jr, Gregoratos G, Russell RO, Ryan TJ, Smith SC Jr (1999) ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery). Circulation 100:1464-480 CrossRef
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  13. Calafiore AM, Teodori G, Di Giammarco G, Vitolla G, Maddestra N, Paloscia L, Zimarino M, Mazzei V (1999) Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg 67:450-56 CrossRef
  14. Poirier NC, Carrier M, Lespérance J, Coté G, Pellerin M, Perrault LP, Pellettier LC (1999) Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass. J Thorac Cardiovasc Surg 117:292-97 CrossRef
  15. Cartier R (1999) Systematic off-pump coronary artery revascularization: expe
• 作者单位：Shreosee Roy (1) (2)
  Kaushik Saha (1) (3)
  Krishnendu Mukherjee (4)
  Santanu Dutta (5)
  Debasis Mukhopadhyay (1)
  Indranil Das (1)
  Gargi Raychaudhuri (6)
  
  1. Department of Pathology, IPGME & R, Kolkata, India
  2. Ganganiketan, Jamtala, Kalna Road, Burdwan, 713101, India
  3. 42/9/2, Sashi Bhusan Neogi Garden Lane, Baranagar, Kolkata, 700 036, India
  4. Department of Immunohematology and Transfusion Medicine, Medical College, Kolkata, India
  5. Department of Cardiothoracic Surgery, IPGME & R, Kolkata, India
  6. Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
  
• ISSN：0974-0449

文摘

Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is associated with intense activation of hemostatic mechanisms. But the precise knowledge of the effects of eliminating CPB in patients undergoing off-pump coronary artery bypass grafting (CABG) are not well established. The present study was carried out to compare and document the changes in selected coagulation and fibrinolysis variables in patients undergoing on-pump and off-pump CABG (OPCAB). A total of 42 patients of on-pump and 31 patients of off-pump CABG were selected for the study. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrinogen and D-dimer levels were measured immediately, 24?h and 7?days after operation and compared with the baseline preoperative values. Statistical analysis was done by mixed ANOVA for repeated measures and Post-hoc tests using the Bonferroni correction, Chi square and unpaired t test. All the parameters were significantly changed (P?CABG patients on immediate and 24?h postoperative period and attained almost same level after 7?days of operation. Fibrinogen level and platelet counts were increased after a sharp fall in the immediate post-operative period whereas D-dimer levels were persistently increased with a sharp peak of rise in the immediate post-operative period in on-pump group. On-pump surgery was associated with excessive fibrinolytic activity immediately after operation. The off-pump group demonstrated less activation of coagulation and fibrinolysis and delayed postoperative response that became almost equal to the on-pump group in the later postoperative period.