• J. Cardiothorac. Vasc. Anesth. · Feb 2005

    Comparative Study

    Hypercoagulability affecting early vein graft patency does not exist after off-pump coronary artery bypass.

    • Robert Poston, Junyan Gu, James Brown, James Gammie, Charles White, Jeffrey Manchio, Richard N Pierson, Bartley P Griffith, Paul Gurbel, Udaya Tandry, and Timothy B Gilbert.
    • Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. rposton@smail.umaryland.edu
    • J. Cardiothorac. Vasc. Anesth. 2005 Feb 1; 19 (1): 11-8.

    ObjectiveHypercoagulability may compromise the patency of bypass grafts. The authors hypothesized that perioperative in vitro platelet responses to varying agonists (eg, thrombin, platelet activating factor, collagen, adenosine diphosphate) correlate with early graft thrombosis after off-pump coronary artery bypass grafting (OPCAB).Design And ParticipantsProspective study of 78 OPCAB patients with 151 venous bypass grafts treated with perioperative aspirin and intraoperative heparin (250 U/kg).SettingTertiary, academic medical center.InterventionsNone.Measurements And Main ResultsHypercoagulability, defined by TEG (maximum amplitude [MA]>70 mm), whole-blood aggregometry (>15 ohms after 5 mcl/mL collagen) or hemoSTATUS (Ch5CR>0.5), was serially assessed around OPCAB. An immediate decline in platelet function after surgery and on postoperative day 1 returned to normal by postoperative day 3 in most patients. Graft blood flow was analyzed intraoperatively, and vein biopsies were analyzed for endothelial disruption. Graft patency was assessed by multichannel computed tomography coronary angiography on postoperative day 5. No differences in any of the platelet function assays were noted for the 8 patients with graft thrombosis (n=8 grafts) versus the 68 patients with all patent grafts (n=129 grafts). Ten patients developed a rise in platelet function postoperatively >1 SD above baseline; only 1 developed graft thrombosis (p=not significant v patients with normal platelet function).ConclusionsOPCAB is not associated with a significant activation in postoperative platelet function. This study suggests that if hypercoagulability exists after OPCAB, it is not involved in the pathogenesis of arterial thrombotic events such as early bypass graft failure.

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