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J Thorac Cardiovasc Surg 2006;131:290-297
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Activation of the coagulation system during coronary artery bypass grafting: Comparison between on-pump and off-pump techniques

^a Division of Cardiac Surgery, Dipartimento d'Emergenza e Trapianti di Organo (D.E.T.O.), University of Bari, Italy
^b Department of Experimental Oncology, Laboratory Unit, Oncology Hospital, IRCCS, Bari, Italy
^c Department of Surgery, Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Ontario, Canada

Received for publication July 19, 2005; revisions received October 6, 2005; accepted for publication October 10, 2005.

^_* Address for reprints: Domenico Paparella, MD, Division of Cardiac Surgery, Dipartimento di Emergenza e Trapianti di Organo (D.E.T.O.), University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy (Email: paparella{at}tin.it).

OBJECTIVE: The activation of the coagulation and fibrinolytic systems and platelet function in patients undergoing coronary artery bypass surgery on-pump or off-pump techniques was compared.

METHODS: Thirty-two patients were randomly assigned to on-pump or off-pump coronary artery bypass grafting. Heparin was given at the same dose. Activation of the coagulation and fibrinolytic systems was evaluated by measurement of several markers. Platelet function was evaluated by in vitro bleeding time test. Blood samples were collected at 7 different times, up to postoperative day 6.

RESULTS: Overall tissue factor production was similar in the two groups. Thrombin formation was more elevated in the on-pump group (P < .001), particularly during the operation; prothrombin fragment 1.2 discharge values were higher than the preoperative ones (P = .002). Levels of tissue-plasminogen activator showed no difference between the groups (P = .1). D-dimers release was higher in the on-pump group (P = .0002). In vitro bleeding time was longer in the on-pump group (P < .0001), particularly in the first 24 hours; it was not prolonged in the off-pump group. In both groups, regardless of aspirin treatment, discharge in vitro bleeding times were lower than the preoperative ones (P < .01).

CONCLUSION: Although the extrinsic coagulation pathway is similarly activated, thrombin formation is more pronounced in patients having on-pump bypass grafting. Patients subjected to off-pump bypass grafting have normally functioning platelets and a weak activation of the fibrinolytic system. At discharge, both groups have preserved platelet function and increased thrombin formation. Further studies with angiographic evaluation are needed to establish a correlation between coagulation parameters, platelet function, and graft patency.

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				D. Paparella, A. Galeone, and G. Scrascia Reply to the editor. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 734 - 734. [Full Text] [PDF]