Use of thrombin generation test for monitoring hemostasis in coronary bypass surgery

Abstract

To evaluate the parameters of the thrombin generation test (TGT) in coronary artery disease (CAD) patients on prolonged aspirin therapy during on-pump coronary artery bypass grafting (CABG) after donor platelet concentrate transfusion. A total of 148 patients with CAD on prolonged aspirin therapy (75–100 mg/day) who have undergone elective on-pump CABG were consecutively included in the study. Patients were divided randomly into two groups. Group 1 (n = 76) received donor platelet transfusions after cardiopulmonary bypass, whereas Group 2 (n = 72) did not. TGT parameters were measured using an analyzer at pre-, intra-, and early postoperative periods. Activation of the endogenous thrombin potential was observed in patients on prolonged aspirin therapy in the pre- and intraoperative periods, as confirmed by high peak thrombin and increased velocity index. The activation time of the prothrombinase complex and thrombin generation time were greater than the control group. The blood hemostatic potential in patients who did not receive transfusions in the early postoperative period decreased up to the level of the control group in the extended time parameters. Hemostatic potential in plasma in patients on aspirin was preserved. Given the laboratory test results and clinical data, platelet concentrate transfusion is unnecessary for prevention.

The combined effects of the microcirculatory status and cardiopulmonary bypass on platelet count and function during cardiac surgery

“…Among the latter, shear-stress plays an important role as a platelet activator, and impaired microcirculatory conditions may create the substrate for platelet adhesion, activation, and loss of count and function. Therefore, coronary surgery with CPB represents an interesting setting where pre-operative endothelial dysfunction, intraoperative microvascular impairment, and platelet activation are simultaneously present and may concur in determining post-operative organ dysfunction [13][14][15][16].…”

Thrombin: A Pivotal Player in Hemostasis and Beyond

“…[144][145][146] Ex vivo thrombin generation capacity has further been found decreased in the postoperative phase, indicated by prolonged lag time and low ETP and peak thrombin formation compared with healthy individuals. 147 This indicates excessive prothrombin consumption and decreased hemostatic capacity, which may enhance bleeding risk in the early postoperative phase. The potential of in vivo and ex vivo thrombin formation markers to predict postoperative bleeding in cardiopulmonary bypass surgery has been explored by our group 144 and others.…”

Platelet Function during Platelet-Rich Plasma Sequestration in Complex Cardiac Surgical Procedures - Prospective Controlled Study

“…Shed blood, if reinfused, increases platelet activation. Plasmin erodes the clot and directly activates platelet consumption [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”