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Original Articles: Cardiovascular

Thrombophilic Variables Do Not Increase the Generation or Procoagulant Activity of Thrombin During Cardiopulmonary Bypass

^a Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland
^b Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland
^c Department of Hematology, Helsinki University Central Hospital, Helsinki, Finland
^d Laboratory Division (HUSLAB), Helsinki University Central Hospital, Helsinki, Finland
^e Department of Pediatrics, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland

Accepted for publication September 24, 2007.

^_* Address correspondence to Dr Raivio, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Post box 340, Helsinki, FIN-00029 HUS, Finland (Email: peter.raivio{at}hus.fi).

Background: The generation of thrombin and its procoagulant activity are upregulated during cardiopulmonary bypass (CPB). Thrombophilia associates with increased basal thrombin generation and might therefore propagate thrombin generation during CPB. The objective of this study was to test whether preoperative thrombophilic variables associate with increased generation of thrombin or its procoagulant activity during and after CPB.

Methods: Comprehensive thrombophilia screening was performed in patients (n = 100) before elective coronary artery bypass grafting (CABG) with CPB. Markers of thrombin generation (prothrombin fragment F1+2), its procoagulant activity (soluble fibrin complexes), and a marker of fibrin degradation (D-dimer) were measured serially at eight time points before, during, and after CABG.

Results: Abnormal thrombophilia screening was common (44%). While patients with thrombophilic variables had higher preoperative prothrombin fragment F1+2 than others (median [interquartile range] 0.55 [0.34] vs 0.45 (0.21) nmol/L, p = 0.009) they did not have higher F1+2, D-dimer, or soluble fibrin complex levels during CPB or postoperatively than patients without thrombophilic variables.

Conclusions: Preoperative thrombophilic variables do not associate with perioperative thrombin generation or its procoagulant activity in patients undergoing CABG. Our results do not support routine thrombophilia screening before CABG.

This article has been cited by other articles:

				P. Raivio, R. Lassila, and J. Petaja Thrombin in myocardial ischemia-reperfusion during cardiac surgery. Ann. Thorac. Surg., July 1, 2009; 88(1): 318 - 325. [Abstract] [Full Text] [PDF]

				R. Colman Invited Commentary Ann. Thorac. Surg., February 1, 2008; 85(2): 542 - 542. [Full Text] [PDF]