Accelerated activation of the coagulation pathway during cardiopulmonary bypass in aortic replacement surgery: a prospective observational study

Abstract

BackgroundAny form of surgery or tissue damage causes release of tissue factor into the circulation. This may lead to the accelerated consumption of coagulation factors, resulting in severe consumptive coagulopathy. In this study, we compared the molecular markers involved in coagulation activation during cardiopulmonary bypass (CPB) between patients who underwent aortic replacement surgery and those who underwent valve surgery.MethodsThis prospective observational study was performed in each 14 patients who underwent aortic replacement surgery or valve surgery. We evaluated the differences in the levels of fibrinogen, activated factor VII (FVIIa), thrombin–antithrombin complex (TAT), and soluble fibrin monomer complex (SFMC) during surgery between these two groups.ResultsThe change in fibrinogen levels showed no difference between the groups. The magnitude of increase in TAT was much larger in patients who underwent aortic replacement surgery than in those who underwent valve surgery (173.6 vs. 49.4 ng/mL; p = 0.0001). More importantly, the elevation of FVIIa was significantly higher in patients who underwent aortic replacement (28.5 vs. 19.0 mU/mL; p = 0.0122). The magnitude of increase in SFMC was also larger in the aortic replacement surgery.ConclusionsThe activation of coagulation during CPB was dramatically higher in the aortic replacement surgery compared with the valve surgery, probably owing to the activation of the extrinsic coagulation pathway in the former. This could potentially exacerbate consumptive coagulopathy after CPB termination in patients who underwent aortic replacement, possibly resulting in massive hemorrhage due to impaired hemostasis.

Utility of Thromboelastography to Identify Hypercoagulability in Lung Cancer Related Ischemic Stroke Patients

“…Tables 1 and 2 showed the demographic, clinical and laboratory data for patients and controls. In this study, 27 According to routine coagulation tests, the levels of PLT count, FIB and plasma D-dimer were significantly higher in LCIS group and LC group (P < 0.05). And the levels of FIB and plasma D-dimer were higher in LCIS group than that in LC group (P < 0.05).…”

“…In addition, higher levels of thrombin-antithrombin complex (TAT) and soluble fibrin monomer complex (SFMC) could serve as molecular markers of coagulation activation during cardiopulmonary bypass in patients who underwent aortic replacement surgery. 27 The TAT reflects the generation of thrombin through the prothrombinase Comparison of major TEG parameters among 3 groups. R-time and K-time were significantly shorter while Angle, MA and CI levels were significantly higher in LCIS group and LC group than that in HC group (Kruskal-Wallis H test, P < 0.05).…”

Plasma Proteolytic Cascade Activation during Neonatal Cardiopulmonary Bypass Surgery

“…10,11 Tissue factor-dependent coagulation and inflammation, as a result of monocyte activation and surgical trauma, also occur during CPB. [12][13][14][15] In addition, coagulation proteases can cross-activate other plasma proteolytic cascades and vice versa. 16,17 Thus, the neonate undergoing CPB is susceptible to widespread and unregulated proteolysis with consumption of plasma protease inhibitors that regulate blood coagulation, fibrinolysis, complement and inflammation.…”

Catastrophic Intracardiac Thrombosis During Emergency Repair of an Expanding Aortic Pseudoaneurysm: A Case Report

“…Aortic surgery in particular, with its generally longer CPB times, is associated with significantly higher thrombin generation than other types of cardiac surgery. 9 This case was a repeat sternotomy with ascending aorta and hemiarch replacement, likely resulting in widespread endothelial injury at the macrovasculature and microvasculature levels.…”