Cardiopulmonary bypass surgery was associated with increased thrombin generation despite heparin, with a close correlation between thrombin generation and inhibition (r = 0.882).
Observational
How does cardiopulmonary bypass surgery affect thrombin generation and inactivation markers?
Cardiopulmonary bypass surgery induces significant thrombin generation despite heparinization, which normalizes within 24 hours post-surgery, though D-dimer levels remain elevated.
Effect estimate: r = 0.882
Activation of coagulation was studied during the peri-operative period in patients undergoing cardiopulmonary bypass (CPB) surgery using activation markers which have recently become available: prothrombin fragment F1 + 2 (F1 + 2), which is a measure of total thrombin generation, and thrombin-antithrombin complex, which is a measure of inactivation of free thrombin by antithrombin. Levels of the specific marker of fibrin breakdown, D-dimer, were also determined. F1 + 2 levels were assessed using a newly developed ELISA described herein which employs a neoantigen-specific capture antibody raised using a synthetic peptide; the latter antibody has been pre-adsorbed against prothrombin to ensure high specificity for F1 + 2. Increased generation of thrombin during surgery was clearly demonstrated despite maintenance of a high concentration of heparin during the period of extracorporeal blood circulation. There was a close association (r = 0.882) between the generation of thrombin (F1 + 2 levels) and its inhibition (TAT levels). Differences were noted, however, between the information provided by F1 + 2 and TAT, which are interpreted with regard to the different in vivo fates of F1 + 2 and thrombin. The enhanced activation and inhibition of coagulation observed during CPB was suppressed once physiological blood circulation was restored, with F1 + 2 returning to pre-surgical levels within 24 h after surgery. During the post-operative period D-dimer levels, which rose in concert with F1 + 2 and TAT levels, remained highly elevated, suggesting that not all of the generated thrombin was inactivated by antithrombin.(ABSTRACT TRUNCATED AT 250 WORDS)
Boisclair et al. (Fri,) conducted a observational in Cardiopulmonary bypass (CPB) surgery. Cardiopulmonary bypass (CPB) surgery vs. Pre-surgical levels was evaluated on Thrombin generation (F1 + 2 levels) and its inhibition (TAT levels) (r = 0.882). Cardiopulmonary bypass surgery was associated with increased thrombin generation despite heparin, with a close correlation between thrombin generation and inhibition (r = 0.882).