Evaluation of hypercoagulability status after off-pump coronary artery bypass grafting using rotation thromboelastometry

Background: Recently, off-pump coronary artery bypass (OPCAB) surgery, which dose not require cardiopulmonary bypass (CPB), has been commonly performed. It has been revealed that OPCAB decreases the incidence of perioperative infarctions triggered by thrombolism from aorta. However, OPCAB has also been associated with postoperative stroke. Thromboelastography (TEG) is a bedside blood test that can be used to defi ne the viscoelastic properties of blood. ROTEM® analyzer (Pentapharm GmbH, Munich,Germany) is a modifi ed form of TEG. The aim of this study is to evaluate the hypercoagulability status of the blood after OPCA Bsurgery by using ROTEM®.Methods: This is a prospective study of 10 OPCAB patients each who underwent OPCAB, on-pump surgery, AAA repair, and VATS for a period of 7 days with ROTEM® assays. From ROTEM data, Coagulation Index (CI) was calculated for each patient.Results: The CI values of OPCAB patients from the extrinsic assay during the perioperative period were consistent with hypercoagulability. In comparison between the OPCAB and CPB patients from the extrinsic assay, a signifi cant difference was observed during the postoperative state. Comparison between the OPCAB and AAA patients revealed significantly higher CI values in the OPCAB patients immediately after surgery. Similarly, comparison between the OPCAB and VATS patients revealed significantly higher CI values in the OPCAB patients through the entire course of measurements.Conclusions: A state of hypercoagulability of the blood, as measured by ROTEM, existed in the OPCAB patients beyond acute postoperative stage. The extrinsic coagulation, in particular, was hypercoagulable in the OPCAB patients.