Effects of Extracorporeal Circulation on Thrombin-Antithrombin III and Prothrombin Fragment 1+2 Levels

Abstract

Cardiopulmonary bypass may alter the factors responsible for normal hemostasis by exposing blood to nonendothelial surfaces, for example, extracorporeal circuits. To evaluate the probable effect of extracorporeal circulation on hemostasis, we measured thrombin-antithrombin III complex (TAT) and prothrombin fragment 1+2 (PF 1.2) plasma levels, which are the biologic markers of in vivo coagulation, in 20 patients who underwent coronary artery bypass grafting (CABG). Postoperative PF 1.2 levels were higher in comparison to the preoperative concentrations of the parameter. Preoper ative and postoperative TAT concentrations showed no statistically significant difference. The increment in the PF 1.2 levels in CABG patients might suggest ongoing subclinical hemostatic activation associated with CABG. Further investigations are needed to clarify the exact relationship between increased PF 1.2 levels and thrombotic complications observed in CABG patients. Hemostatis in CABG is still an enigma and remains to be eluciated.

Keywords

Extracorporeal circulation Thrombin-antithrombin III complex Prothrombin fragment 1+2

References

1. Kay PH . Techniques in Extracorporeal Circulation. 3d ed. London: Butterworth-Heinemann, 1992:144-144.

2. Paramo JA , Rifon J , Llorens R , et al. Intraoperative and postoperative fibrinolysis in patients undergoing cardiopulmonary bypass surgery. Haemostasis 1991;21:58-58.

3. Edmunds LH , Ellison N , Colman RW , et al. Platelet function during cardiac operation: Comparison of membrane and bubble oxygenators. J Thorac Cardiovasc Surg 1982;83:805-805.

4. Fareed J , Brick RL , Hoppensteadt DA , et al. Molecular markers of hemostatic activation: Applications in the diagnosis of thrombosis and vascular and thrombotic disorders. Clin Appl Thromb Hemost 1995;1:87-87.

5. Slaughter TF , Le Bleu TH , Douglas JM , et al. Characterization of prothrombin activation during cardiac surgery by hemostatic molecular markers. Anesthesiology 1994;80:520-520.

6. Rifon J , Paramo JA , Prosper I , et al. Thrombin-antithrombin complexes and prothrombin fragment 1+2 in aortocoronary bypass surgery relation to graft occlusion. Hematol Pathol 1994;8:35-35.

7. Welters I , Menges T , Ballesteros M , et al. Thrombin generation and activation of the thrombomodulin protein C system in open heart surgery depend on the underlying cardiac disease. Thromb Res 1998;92:1-1.