Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study / Alterações hemostáticas e clínicas em cirurgias de revascularização miocárdica com e sem circulação extracorpórea: estudo prospectivo randomizado

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Objective: To delineate the effects of extracorporeal bypass on biomarkers of hemostasis, fibrinolysis, and inflammation and clinical sequelae. Methods: Patients were assigned prospectively and randomly to either on-pump (n=41) or off-pump (n=51) coronary bypass surgery. The concentrations of C-reactive protein (CRP), fibrinogen, D-dimer, and plasminogen activator inhibitor type 1 (PAI-1) in blood were quantified before and after (1 hour and 24 hours) surgery. Similar surgical and anesthetic procedures were used for both groups. Clinical events were assessed during initial hospitalization and at the end of 1 year. Results: The concentrations of PAI-1 and d-dimer were greater compared with preoperative values 1 hour and 24 hours after surgery in both groups, but their concentrations increased to a greater extent 24 hours after surgery in the on-pump group (p<0.01). The concentration of CRP did not change appreciably immediately after surgery in either group but increased in a parallel fashion 24 hours after either on-pump or off-pump surgery (p<0.01). Bypass surgery in the on-pump group was associated with greater blood loss during surgery and more bleeding after surgery (p0.01). The incidence of all other complications was similar in the 2 groups. Conclusion: On-pump surgery was associated with biochemical evidence of a pro-thrombotic state early after surgery but no greater incidence of thrombotic events. The pro-thrombotic state may have been a consequence of extracorporeal bypass, compensation in response to more bleeding, or both in patients undergoing on-pump surgery.

ASSUNTO(S)

cardiac surgery inflamação circulação extracorpórea inflammation trombose/cirurgia ponte de artéria coronária off-pump cabg thrombosis/surgery revascularização miocárdica coronary artery bypass graft ponte de artéria coronária sem circulação extracorpórea extracorporeal circulation

ACESSO AO ARTIGO

Documentos Relacionados