Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?

Mariani, Massimo A.; Gu, Yongquan; Boonstra, Piet W.; Grandjean, Jan G.; Oeveren, Willem van; Ebels, Tjark

doi:10.1016/s0003-4975(99)00265-9

Cited by 176 publications

(110 citation statements)

References 18 publications

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“…The observation of significantly increased D-dimer levels in on-pump group B at the end of surgery and the equalization of elevated D-dimer levels between the on-pump and off-pump groups 24 hours after the surgery is in agreement with the findings of others. 10,11) The question of a possibly delayed increase in coagulant and fibrinolytic activity in off-pump surgery arises and slightly controversial clinical conclusions [23][24][25] should warrant further studies. Thromboelastography provides a complete graphical representation of blood coagulation and eventual subsequent lysis of the clot in almost real time.…”

Section: Discussionmentioning

confidence: 99%

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

et al. 2007

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SUMMARYThe aim of this preliminary, prospective, randomized study was to compare rotation thromboelastography (roTEG) results and D-dimer levels in off-pump versus on-pump coronary surgery in order to identify the activation of fibrinolysis.Twenty patients scheduled for coronary bypass grafting were assessed (off-pump group A, n = 10; on-pump group B, n = 10). Blood samples for roTEG examination were taken preoperatively (t 0 ), 15 minutes after sternotomy (t 1 ), on the completion of peripheral bypass anastomoses (t 2 ), and at the end of procedures (t 3 ). The time points for D-dimer levels analyses were before operation, at the end of procedures, and 24 hours later.A certain degree of roTEG signs of fibrinolysis was noticed at time t 2 in both groups and in group B these marks were quite widely, but not significantly expressed (P for intergroup differences for Lysis on Set Time at 60 and 150 minutes were P = 0.190 and P = 0.122, respectively), borderline differences were found for Maximum Clot Firmness (P = 0.082) with a lower mean value for group B (arithmetic means [95% confidence intervals] -57.7 [54.2; 61.2] mm). Completely expressed roTEG signs of hyperfibrinolysis were observed in 2 patients from group B. In group B also the highest geometric means of Ddimers (1326.0 [943.5; 1863.6] ng mL -1 ) and thus a dramatic intergroup difference (P < 0.001) were observed at the end of surgery; 24 hours later the significantly elevated Ddimer levels in both groups (A: 1070.0 [723.5; 1582.6] versus B: 1093.3 [732.0; 1632.9] ng mL -1 ) were equalized (P = 0.932). Our roTEG results display a slightly greater, but fairly subtle activation of fibrinolysis during the course of cardiopulmonary bypass, compared to off-pump cardiac surgery. (Int Heart J 2007; 48: 57-67)

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Section: Discussionmentioning

confidence: 99%

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

et al. 2007

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“…Several reports have documented the existence of a relative hypercoagulable state after off-pump surgery, associated with higher levels of postoperative platelet activity and a decrease in platelet sensitivity to aspirin after OPCAB. [52][53][54][55][56][57][58][59][60] Moreover, in some early studies of graft patency after OPCAB, vein graft occlusion was noticeably higher both early and late after OPCAB compared with conventional CABG. 53,61 Questions were therefore raised about whether antiplatelet therapy with aspirin alone would be sufficient for patients after OPCAB, and as early as 2003, leading off-pump centers instituted policy changes to treat all OPCAB patients with both clopidogrel and aspirin after surgery for a duration of 3 months.…”

Section: Off-pump Cabgmentioning

confidence: 99%

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Kulik¹,

Ruel²,

Jneid³

et al. 2015

Circulation

343

185

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“…Therefore, we introduce warfarin for patients with postoperative AF to prevent cerebrovascular accidents, even though almost all cases of AF discontinue in the short-term because coagulability may be accelerated after OPCAB. 16 Furthermore, angiotensin-converting enzyme inhibitors and antiinflammatory drugs have been reported to offer protection against postoperative AF and we have considered them as well. 17 The use of postoperative blood transfusion was significantly higher in the elderly group (78.0% elderly vs 37.2% younger, p<0.0001).…”

Section: Discussionmentioning

confidence: 99%

Hospital and Mid-Term Outcomes in Elderly Patients Under-going Off-Pump Coronary Artery Bypass Grafting-Comparison With Younger Patients-

Nakamura¹,

Nakano²,

Nakatani³

et al. 2004

Circ J

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Background Clinical outcomes and problems following off-pump coronary artery bypass grafting (OPCAB) in elderly patients have not been clarified. Methods and ResultsThe surgical results of elderly patients aged 75 years or older (n=50; 38 males, mean age, 78.8 years) were reviewed and compared with those of younger patients (n=95; 79 males, mean age, 63.0 years). The EuroSCORE score was 6.9±3.5 in the elderly group and 3.0±2.4 in the younger group (p<0.0001). There were no hospital deaths in either group. There was no significant difference in the postoperative complication rate except for atrial fibrillation (40.0% elderly vs 24.2% younger, p=0.0479). Postoperative intensive care unit and hospital stays did not differ. The frequency of blood transfusion was significantly higher in the elderly group (78.0% elderly vs 37.2% younger, p<0.0001). During the mean follow-up of 18.6±8.8 months, there was 1 sudden death in the elderly group, but no cardiac deaths in either group. The 32-month cardiac event-free and survival rates were similar for the 2 groups. Conclusion OPCAB provides satisfactory clinical outcomes for elderly as well as younger patients. (Circ J 2004; 68: 1184 -1188

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Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?

Cited by 176 publications

References 18 publications

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Hospital and Mid-Term Outcomes in Elderly Patients Under-going Off-Pump Coronary Artery Bypass Grafting-Comparison With Younger Patients-

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