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J Thorac Cardiovasc Surg 2003;125:336-343
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Coagulation and fibrinolytic markers in a two-month follow-up of coronary bypass surgery

From the Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS,^a Department of Pharmacological Sciences, E. Grossi Paoletti Center, University of Milan,^b and Department of Biostatistics, European Institute of Oncology,^c Milan, Italy.

This work was supported in part by a grant from the Italian Ministry of Health (ICS 030.6 RF99.14).

Received for publication Feb 14, 2002. Revisions requested June 13, 2002; revisions received June 27, 2002. Accepted for publication July 15, 2002. Address for reprints: Alessandro Parolari, MD, PhD, Department of Cardiac Surgery, University of Milan, Centro Cardiologico, Fondazione Monzino IRCCS, Via Parea, 4, 20138, Milan, Italy (E-mail: alessandro.parolari{at}cardiologicomonzino.it).

Objectives: The alterations of the coagulation-fibrinolytic profile immediately and up to few days after cardiac surgery have been widely documented. However, less information is available on whether these alterations persist for prolonged periods of time after the operation. In this study we have evaluated the coagulation-fibrinolytic profile of patients who underwent coronary artery surgery with cardiopulmonary bypass during a 2-month follow-up period.
Methods: Twenty-six patients (age range, 50-75 years) were studied. Blood samples were collected before the intervention and at different time points postoperatively up to 2 months after the operation. Measurement of selected coagulation-fibrinolytic variables was carried out in plasma from 16 patients. Evaluation of tissue factor activity determined as procoagulant activity was performed in peripheral blood mononuclear leukocytes obtained from 10 patients.
Results: Antigenic levels of clottable fibrinogen, prothrombin fragment F1.2, D-dimer, and thrombin-antithrombin complex were significantly increased during the first week after the intervention compared with preoperative values. Prothrombin fragment F1.2 levels returned to normal within 15 days, fibrinogen levels normalized within 30 days, and thrombin-antithrombin complex levels normalized at 45 days, whereas D-dimer values were still significantly higher 60 days postoperatively respective to baseline values. There was a trend toward an increased procoagulant activity from peripheral blood mononuclear leukocytes 4 days after the operation, whereas no changes of factor VII measured either as antigen or in its coagulant and activated forms were recorded throughout the study.
Conclusions: A marked activation of the coagulation-fibrinolytic system occurs after cardiopulmonary bypass and lasts for at least 2 months thereafter. This finding suggests that these alterations might account for the increased thrombotic risk of these patients during the postoperative period.

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