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Ann Thorac Surg 2005;80:586-593
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Hemostasis in Off-Pump Compared to On-Pump Coronary Artery Bypass Grafting: A Prospective, Randomized Study

^a Department of Cardiothoracic Surgery and Anesthesia, Karolinska University Hospital, Stockholm, Sweden
^b Department of Coagulation Research, Karolinska University Hospital, Stockholm, Sweden
^c Department of Surgery, Ullevål University Hospital, Oslo, Norway

Accepted for publication February 3, 2005.

^_* Address reprint requests to Dr Vedin, Department of Thoracic Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden (Email: jenny.vedin{at}karolinska.se).

BACKGROUND: We hypothesized that off-pump coronary artery bypass grafting has less impact on the hemostatic systems than on-pump surgery.

METHODS: 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, 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.

RESULTS: 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. 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).

CONCLUSIONS: 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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