ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Lucia Torracca
Ottavio Alfieri
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pappalardo, F.
Right arrow Articles by D'Angelo, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pappalardo, F.
Right arrow Articles by D'Angelo, A.
Related Collections
Right arrow Extracorporeal circulation

Ann Thorac Surg 2006;81:886-891
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Phosphorylcholine Coating May Limit Thrombin Formation During High-Risk Cardiac Surgery: A Randomized Controlled Trial

Federico Pappalardo, MD a , * , Patrizia Della Valle, PhD b , Giuseppe Crescenzi, MD a , Chiara Corno, PhD, MS a , Annalisa Franco, MD a , Lucia Torracca, MD c , Ottavio Alfieri, MD c , Laura Galli, PhD b , c , d , Alberto Zangrillo, MD a , Armando D'Angelo, MD b

a Department of Cardiovascular Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
b Coagulation Service and Thrombosis Research Unit, IRCCS San Raffaele Hospital, Milan, Italy
c Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy
d Epidemiology Unit, IRCCS San Raffaele Hospital, Milan, Italy

Accepted for publication September 1, 2005.

* Address correspondence to Dr Pappalardo, Department of Cardiovascular Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Via Olgettina, 60, Milan 20132, Italy (Email: pappalardo.federico{at}hsr.it).

BACKGROUND: During cardiopulmonary bypass, blood contact with the large nonendothelial surfaces of the extracorporeal circuit induces activation and consumption of platelets and plasma coagulation factors. Phosphorylcholine (Pc) coating of oxygenators has been designed to improve surface biocompatibility. We evaluated the effects of a Pc-coated oxygenator on blood coagulation in patients undergoing high-risk open heart surgery and receiving tranexamic acid.

METHODS: Thirty-nine patients undergoing reoperative valvular or combined procedures were randomized to the use of an oxygenator treated with Pc coating (Pc group) or of a standard oxygenator (control group). Platelet count, soluble CD40 ligand, fibrinogen, antithrombin, D-Dimer, prothrombin fragment 1.2 (F1.2), and free plasma hemoglobin levels were measured at baseline, at aortic unclamping, and at arrival in the intensive care unit.

RESULTS: Postoperative bleeding, need for blood products, and clinical outcomes were similar in the two groups. At unclamping, F1.2, a marker of in vivo thrombin formation, increased to a greater extent in control patients than in Pc patients (p = 0.02), and in the latter group of patients was positively correlated with aortic cross-clamp times (r = 0.70). Relative to baseline values, the percent decrease in platelet count, fibrinogen, and antithrombin levels was not significantly different in Pc patients and in control patients after adjustment for multiple comparisons, but the percent decrease in platelet counts was negatively correlated with F1.2 levels in the entire series of patients (r = -0.62, p < 0.0001). All the evaluated parameters were similar in the two groups of patients at arrival in the intensive care unit.

CONCLUSIONS: For patients undergoing high-risk open heart surgery and receiving tranexamic acid, a phosphorylcholine-coated oxygenator may reduce intraoperative thrombin formation and the associated consumption of platelets, fibrinogen, and antithrombin.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.