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J Thorac Cardiovasc Surg 2005;130:303-308
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Increased prothrombotic state lasting as long as one month after on-pump and off-pump coronary surgery

^a Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS
^b Biostatistics Unit, Centro Cardiologico Monzino IRCCS
^c Department of Pharmacological Sciences, University of Milan, Milan, Italy

Received for publication July 12, 2004; revisions received October 27, 2004; accepted for publication November 2, 2004.

^_* Address for reprints: Alessandro Parolari, MD, PhD, Department of Cardiac Surgery, University of Milan, Centro Cardiologico Fondazione Monzino IRCCS, Via Parea, 4, 20138, Milan, Italy (Email: alessandro.parolari{at}cardiologicomonzino.it).

OBJECTIVE: This study investigated whether the activation of coagulation, fibrinolysis, and endothelium occurring during the first postoperative month after on-pump coronary artery bypass surgery differs from that after off-pump coronary artery bypass grafting.

METHODS: Thirty-five patients candidates to coronary surgery were randomized to undergo on-pump (n = 18) or off-pump (n = 17) coronary artery bypass grafting. Blood samples were collected before the intervention and to 1 month after surgery.

RESULTS: Prothrombin fragment F1.2, thrombin-antithrombin complex, and D-dimer increased after surgery and were persistently higher than preoperative values as late as 30 postoperative days in both on- and off-pump groups; higher levels of these variables were detected after on-pump surgery relative to off-pump surgery only at the time point after termination of cardiopulmonary bypass (fragment F1.2 and thrombin-antithrombin complex) or from bypass end to 8 postoperative days (D-dimer). Fibrinogen levels decreased after surgery and then increased in parallel in both groups to 8 days after surgery. The von Willebrand factor level increased postoperatively in both groups and returned to baseline 30 days after surgery; it was higher after on-pump surgery from bypass end to 8 postoperative days. Soluble vascular cell adhesion molecule 1 was increased significantly from baseline in both groups 30 days after surgery, with no difference between groups.

CONCLUSION: Patients undergoing off-pump surgery showed protection against activation of coagulation and fibrinolysis and against endothelial injury only during the intraoperative period; this was followed by the development of a prothrombotic pattern comparable to that of patients undergoing on-pump surgery lasting at least as late as 30 days after surgery.

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