OBJECTIVES: Changes in hemostasis after off-pump coronary artery bypass grafting are still being discussed. There is a lack of information about platelet activity and aspirin efficacy after coronary artery bypass grafting. The aim of this study was to assess and compare platelet activity and aspirin efficacy early and late after off-pump and on-pump coronary artery bypass grafting. METHODS: Eighty patients were enrolled in a prospective randomized study. Platelet activity was determined based on membrane expression of antigen CD62P (P-selectin) by means of flow cytometric analysis. Aspirin efficacy was assessed by using arachidonic acid-induced platelet aggregation. Blood samples were collected before the operation, immediately postoperatively, and on days 1, 2, 5, and 30. RESULTS: In the off-pump group expression of P-selectin was markedly increased in comparison with preoperative values, with a maximum difference observed on day 2 (+53%, P = .02), and it was significantly higher compared with that seen in the on-pump group on days 2 and 5 (+53% vs +4%, P = .004, and +20% vs -16%, P = .005). On day 30, P-selectin expression was similar both between the groups and in comparison with the preoperative values. Arachidonic acid-induced platelet aggregation was gradually decreasing until day 30, but on day 2, there was an unexpected increase in aggregation that was more expressed in the off-pump group. CONCLUSIONS: The platelet activity is higher in the early postoperative period in off-pump compared with on-pump coronary artery bypass grafting. The present aspirin strategy seems to be insufficient in the early postoperative period, irrespective of the surgical technique used.
- MeSH
- analýza přežití MeSH
- Aspirin aplikace a dávkování MeSH
- financování organizované MeSH
- hodnocení rizik MeSH
- interval spolehlivosti MeSH
- koronární bypass bez mimotělního oběhu metody škodlivé účinky MeSH
- koronární bypass metody škodlivé účinky MeSH
- koronární stenóza diagnóza chirurgie mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- P-selektin analýza MeSH
- pooperační péče MeSH
- pravděpodobnost MeSH
- předoperační péče MeSH
- přežívání štěpu MeSH
- prognóza MeSH
- prospektivní studie MeSH
- rejekce štěpu MeSH
- rozvrh dávkování léků MeSH
- senioři MeSH
- tkáňový faktor metabolismus MeSH
- výsledek terapie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
Although in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, detailed knowledge of fibrinolysis during various settings of coronary surgery is still limited. Sixty-five patients scheduled for coronary surgery were randomized into 3 groups: group A--conventional coronary artery bypass grafting, group B--off-pump surgery, and group C--coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of reinfusion of cardiotomy blood into the circuit. The sampling time points for rotation thromboelastographic evaluations were as follows: preoperatively, 15 minutes after sternotomy, on the completion of peripheral bypass anastomoses, at the end of the procedures, and 24 hours after the end of surgery. D-dimer levels were evaluated before surgery, at the end of procedures, and 24 hours after surgery. Thromboelastographic signs of fibrinolysis (evaluated by Lysis Onset Time-intergroup differences at 60 and 150 minutes of assessment: P = 0.003 and P < 0.001, respectively) were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C. At the other sampling times all thromboelastographic parameters were similar in all groups. In group A, no exceptional bleeding tendency (during 24 hours), as compared to groups B and C (geometric means and 95% confidence intervals: group A: 686.7 [570.8; 826.1] mL, group B: 555.3 [441.3; 698.9] mL, group C: 775.6 [645.1; 932.3] mL, P = 0.157), and no significant correlations between Lysis Onset Time, postoperative blood loss, and D-dimer levels were found. No significant differences in postoperative blood loss related to cardiac surgeons and assistant surgeons were detected. Thromboelastographic signs of increased fibrinolysis were detectable in the important proportion of coronary surgery patients operated on with the use of conventional cardio-pulmonary bypass, but not in off-pump patients and those operated on with the biocompatible surface-modified circuit without reinfusion of cardiotomy suction blood. These signs resolved spontaneously at the end of surgery and were not associated with increased postoperative bleeding. No significant correlation with D-dimer levels was found.
- MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- fibrinolýza fyziologie MeSH
- financování organizované MeSH
- koronární bypass bez mimotělního oběhu MeSH
- koronární bypass metody MeSH
- lidé MeSH
- pooperační krvácení MeSH
- prospektivní studie MeSH
- senioři MeSH
- tromboelastografie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
Cíl studie: Fast-track (opiátová složka alfentanil) a ultra-fast-track (opiátová složka remifentanil) - metody vedení celkové anestezie - se na našem pracovišti standardně užívají od roku 2001. Cílem práce je porovnat výsledky obou metod. Typ studie: Prospektivní observační studie. Název a sídlo pracoviště: Kardiochirurgická klinika FN Královské Vinohrady a 3. LF UK, Praha. Materiál a metody: V prospektivní studii bylo v průběhu roku 2006 sledováno 71 pacientů (alfentanil 32, remifentanil 39) podstupujících všechny typy standardních kardiochirurgických operací. Sledovány byly tyto parametry: čas do extubace, délka pobytu na jednotce pooperační a resuscitační péče, celková délka pobytu na kardiochirurgické klinice, výskyt pooperační fibrilace síní, hodnoty krevních plynů a hodnocení pooperační bolesti (měřena 1 hodinu po extubaci, 1. pooperační den pomocí vizuální analogové stupnice bolesti a zkrácené formy McGillského dotazníku bolesti) a počet analgetických dávek. Výsledky: Mezi skupinami jsme ve většině sledovaných parametrů neshledali statisticky významné rozdíly. Vnímání pooperační bolesti bylo závislé pouze na věku (p < 0,001) a na pohlaví pacienta (p = 0,042). Závěr: Obě metody umožnily časnou a bezpečnou pooperační extubaci kardiochirurgických nemocných.
Objective: We háve been using fast-track techniques (alfentanil and remifentanil based) for cardiac anae¬sthesia in our department routinely since 2001. The aim of this study was to compare these two methods. Design: A prospective follow-up study. Setting: Department of Cardiac Surgery, University Hospital Královské Vinohrady, Charles University, Pra-gue. Materials and methods: In the prospective follow-up study, 71 consecutive patients (alfentanil 32, remifenta¬nil 39) undergoing common cardiothoracic procedures were observed during 2006.The following parameters were observed: time to extubation, length of ICU stay, length of stay on ward, incidence of postoperative atrial fibrillation, blood gases, postoperative pain grade (assessed 1 hour after extubation and on 1st post¬operative day on the visual analogue pain scale and the SF McGill questionnaire), analgesic requirements. Results:There were no statistically significant differences in the most of observed parameters. Postope¬rative pain was dependent solely on patients age (p <0.001) and gender (p =0.042). Conclusion: Both methods allow early and safe extubation of patients undergoing cardiothoracic surgery.
Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of assessment (P=0.003) and at 150 min of assessment (P<0.001), the mean values of these parameters were significantly lower in group A as compared with both groups B and C, which were statistically indistinguishable. Lysis on set time on the completion of peripheral bypass anastomoses <50% was detected in 12 patients (52.2%) originating from group A. At the other sampling times (preoperatively, 15 min after sternotomy, at the end of the procedures, and 24 h later) thromboelastographic parameters were similar in all groups. In group A no significant correlations between lysis on set time, postoperative blood loss and D-dimer levels were found. Based on our results, thromboelastographic signs of fibrinolysis were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C.
- MeSH
- anastomóza chirurgická MeSH
- biokompatibilní materiály MeSH
- časové faktory MeSH
- design vybavení MeSH
- fibrin-fibrinogen - produkty degradace metabolismus MeSH
- fibrinolýza MeSH
- financování organizované MeSH
- ischemická choroba srdeční chirurgie krev MeSH
- kardiopulmonální bypass přístrojové vybavení MeSH
- koronární bypass bez mimotělního oběhu MeSH
- koronární bypass MeSH
- krvácení při operaci prevence a kontrola MeSH
- lidé MeSH
- prospektivní studie MeSH
- transfuze erytrocytů MeSH
- tromboelastografie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
The aim of this preliminary, prospective, randomized study was to compare rotation thromboelastography (roTEG) results and D-dimer levels in off-pump versus on-pump coronary surgery in order to identify the activation of fibrinolysis. Twenty patients scheduled for coronary bypass grafting were assessed (off-pump group A, n = 10; on-pump group B, n = 10). Blood samples for roTEG examination were taken preoperatively (t0), 15 minutes after sternotomy (t1), on the completion of peripheral bypass anastomoses (t2), and at the end of procedures (t3). The time points for D-dimer levels analyses were before operation, at the end of procedures, and 24 hours later. A certain degree of roTEG signs of fibrinolysis was noticed at time t2 in both groups and in group B these marks were quite widely, but not significantly expressed (P for intergroup differences for Lysis on Set Time at 60 and 150 minutes were P = 0.190 and P = 0.122, respectively), borderline differences were found for Maximum Clot Firmness (P = 0.082) with a lower mean value for group B (arithmetic means [95% confidence intervals]--57.7 [54.2; 61.2] mm). Completely expressed roTEG signs of hyperfibrinolysis were observed in 2 patients from group B. In group B also the highest geometric means of D-dimers (1326.0 [943.5; 1863.6] ng mL(-1)) and thus a dramatic intergroup difference (P < 0.001) were observed at the end of surgery; 24 hours later the significantly elevated D-dimer levels in both groups (A: 1070.0 [723.5; 1582.6] versus B: 1093.3 [732.0; 1632.9] ng mL(-1)) were equalized (P = 0.932). Our roTEG results display a slightly greater, but fairly subtle activation of fibrinolysis during the course of cardiopulmonary bypass, compared to off-pump cardiac surgery.
- MeSH
- fibrin-fibrinogen - produkty degradace metabolismus MeSH
- fibrinolýza fyziologie MeSH
- financování organizované MeSH
- infarkt myokardu chirurgie krev MeSH
- kardiopulmonální bypass metody MeSH
- koronární bypass bez mimotělního oběhu metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- peroperační monitorování MeSH
- prospektivní studie MeSH
- senioři MeSH
- tromboelastografie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
OBJECTIVE: To evaluate and compare hemostatic effects of tranexamic acid vs. aprotinin vs. placebo in off-pump coronary artery bypass (OPCAB) surgery and, in addition, to assess the safety of fibrinolytic inhibitors therapies. METHODS: In a prospective, randomized, double-blind study finally 91 patients undergoing OPCAB were investigated (group A, n=32, tranexamic acid 1g before skin incision and continuously 200mg/h; group B, n=29, aprotinin 1,000,000IU before skin incision and 250,000IU/h; group C, n=30, placebo). RESULTS: Highly significant inter-group differences were found in cumulative blood loss within 4h (geometric means [95% confidence intervals]-group A: 89.3 [72.7, 109.8] mL, group B: 72.3 [49.2, 106.3] mL and group C: 192.3 [151.8, 243.5] mL) (P<0.001), within 8h (group A: 152.1 [120.7, 191.6] mL, group B: 130.3 [88.1, 192.8] mL and group C: 283.8 [226.0, 356.3] mL) (P=0.001), and within 24h postoperatively (group A: 410.3 [337.6, 498.6] mL, group B: 345.8 [256.0, 398.2] mL and group C: 619.8 [524.3, 732.8] mL) (P<0.001). At all time points, placebo group C was significantly distinct from the groups treated with fibrinolytic inhibitors (groups A and B). However, no differences between groups A and B were found. Both mean hemoglobin and hematocrit values 24h postoperatively were different between the groups (P=0.018 and P=0.077, respectively), acheiving the lowest value in group C. Number of re-transfuzed patients was highest in group C, but without statistical significance (either packed red blood cells, P=0.119 or fresh-frozen plasma, P=0.118). We observed one postoperative myocardial infarction in aprotinin treated group B and one temporary postoperative myocardial ischemia in placebo group C, no cerebrovascular or pulmonary embolism was noticed. Treated groups A and B did not demonstrate postoperative increase in mean levels of myocardial enzymes, compared with group C. Significantly higher mean values of D-dimer were found in group C 24h postoperatively (P<0.001). CONCLUSIONS: Both tranexamic acid and aprotinin seem to be similarly effective in the reduction of postoperative blood loss in OPCAB. Tranexamic acid appears to be cost-effective and safe alternative to aprotinin.
- MeSH
- antifibrinolytika analýza škodlivé účinky terapeutické užití MeSH
- aprotinin škodlivé účinky terapeutické užití MeSH
- dvojitá slepá metoda MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- financování organizované MeSH
- hematokrit metody MeSH
- hemoglobiny analýza MeSH
- hemostatika škodlivé účinky terapeutické užití MeSH
- ischemická choroba srdeční etiologie MeSH
- koronární bypass bez mimotělního oběhu metody MeSH
- kreatinkinasa analýza MeSH
- krvácení při operaci prevence a kontrola MeSH
- kyselina tranexamová škodlivé účinky terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- myokard enzymologie MeSH
- nemoci srdce chirurgie MeSH
- pooperační komplikace etiologie MeSH
- pooperační krvácení prevence a kontrola MeSH
- prospektivní studie MeSH
- senioři MeSH
- troponin I analýza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
