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Ann Thorac Surg 1999;67:1370-1375
© 1999 The Society of Thoracic Surgeons

Original Articles

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

Massimo A. Mariani, MD, PhDa, Y. John Gu, MD, PhDa, Piet W. Boonstra, MD, PhDa, Jan G. Grandjean, MD, PhDa, Willem van Oeveren, PhDa, Tjark Ebels, MD, PhDa

a Thoraxcenter, University Hospital of Groningen, Groningen, the Netherlands

Accepted for publication December 3, 1998.

Address reprint requests to Dr Mariani, Thoraxcenter, University Hospital Groningen, Hanzeplein, 1, PO Box 30.001, 9700 RB Groningen, the Netherlands
e-mail: M.Mariani{at}thorax.azg.nl

Background. Hemostasis is preserved after off-pump coronary operations compared with conventional coronary procedures. However, this preserved hemostasis may result in a procoagulant activity.

Methods. We prospectively studied coagulation in 22 patients who underwent off-pump coronary operation either through a midline sternotomy (n = 14) or with minimally invasive anterolateral thoracotomy (n = 8).

Results. Procoagulant activity, represented by prothrombin factor 1 and 2, remained at baseline levels during operation but increased significantly on postoperative day 1. Factor VII remained at baseline levels during the operation but decreased significantly on postoperative day 1. Fibrinolysis was increased as indicated by the fibrin degradation products on postoperative day 1. A promoted hemostasis attributable to endothelial activation was indicated by the increase in von Willebrand factor on postoperative day 1. Platelets counts and platelet activation (ß-thromboglobulin) remained at baseline levels after the operation. No adverse clinical events occurred.

Conclusions. Patients undergoing off-pump coronary operation show an increased procoagulant activity in the first postoperative 24 hours regardless of the surgical approach (midline sternotomy or anterolateral thoracotomy). This procoagulant activity is not mediated by platelet-related factors. Therefore, a specific perioperative prophylactic pharmacologic regimen is advisable.




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