Hemostasis in Off-Pump Compared to On-Pump Coronary Artery Bypass Grafting: A Prospective, Randomized Study
We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery. Thirty-one patients were randomized to on-pump or off-pump coronary artery bypass grafting. Factors of hemostasis as well as markers of endothelial activation were measured u...
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Veröffentlicht in: | The Annals of thoracic surgery 2005-08, Vol.80 (2), p.586-593 |
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Zusammenfassung: | We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery.
Thirty-one patients were randomized to on-pump or off-pump coronary artery bypass grafting. Factors of hemostasis as well as markers of endothelial activation were measured up to 24 hours after the operation: Fibrin D dimer, prothrombin fragment 1+2, α
2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor. Overall hemostasis potential, overall coagulation potential, and overall fibrinolysis potential were determined with a previously developed assay. We also measured platelet count before and after surgery.
Fibrin D dimer and prothrombin fragment 1+2 concentrations were lower during surgery in the off-pump group (
p < 0.001). Four hours after admission to the intensive care unit, these differences were eliminated. α
2-macroglobulin, protein C1 esterase inhibitor, fibronectin, and von Willebrand factor concentrations did not differ between groups (
p = 0.59,
p = 0.28,
p = 0.22, and
p = 0.69). Protein C1 esterase inhibitor and von Willebrand factor concentrations increased over time (
p < 0.001) in both groups. Overall hemostasis potential and overall coagulation potential increased over time (
p < 0.001), while overall fibrinolysis potential decreased (
p < 0.001) with no difference between groups (
p = 0.69,
p = 0.91). Platelet count decreased on the first postoperative day (
p < 0.001), but increased from the first to the third postoperative day (
p = 0.004) in both groups without any inter group difference (
p = 0.82).
There was a tendency toward less activation of coagulation and fibrinolysis in low-risk patients during elective off-pump coronary artery bypass surgery when compared with on-pump surgery. |
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ISSN: | 0003-4975 1552-6259 1552-6259 |
DOI: | 10.1016/j.athoracsur.2005.02.036 |