COAGULATION-FACTOR-V (ARG(506)-]GLN) MUTATION AND EARLY SAPHENOUS-VEIN GRAFT OCCLUSION AFTER CORONARY-ARTERY BYPASS-GRAFTING

The factor V (Arg(506)-->Gln) mutation confers an increased risk of de ep vein thrombosis. whereas its role in saphenous vein graft closure a fter coronary artery bypass grafting (CABG) remains unclear. This stud y examined the anticoagulant response to activated protein C (APC rati o) in relation to the surgical trauma and the significance of the fact or V Leiden mutation in determining postoperative thrombin generation and fibrin formation and the risk of early vein graft occlusion. A tot al of 108 men undergoing elective CABG for exertional angina pectoris (mean age 61.1 +/- 8.7 years) were examined. The patency of saphenous vein grafts was studied at routine reangiography three months after CA BG. Of 100 patients who underwent reangiography, 23 had one or more oc cluded vein grafts at reangiography. Heterozygosity for the factor V ( Ar-506-->Gln) mutation tended to be associated with early saphenous ve in graft occlusion (5/11 carriers vs. 18/89 non-carriers with graft oc clusion, chi(2) = 3.52, p = 0.06), whereas pre- and postoperative APC ratios did not. Pre- and postoperative determinations of prothrombin f ragment 1+2, thrombin-antithrombin complexes and soluble fibrin levels did not differ between patients with and without the mutation. Early saphenous vein graft occlusion after CABG could tentatively be added t o deep vein thrombosis as a vascular complication that can be attribut ed to the factor V (Arg(506)-->Gln) mutation.