Procoagulant activity after off-pump coronary operation: Is the current anticoagulation adequate?

Background. Hemostasis is preserved after off-pump coronary operations comp ared with conventional coronary procedures. However, this preserved hemosta sis may result in a procoagulant activity. Methods. We prospectively studied coagulation in 22 patients who underwent off-pump coronary operation either through a midline sternotomy (n = 14) or with minimally invasive anterolateral thoracotomy (n = 8). Results. Procoagulant activity, represented by prothrombin factor 1 and 2, remained at baseline levels during operation but increased significantly on postoperative day 1. Factor VII remained at baseline levels during the ope ration but decreased significantly on postoperative day 1. Fibrinolysis was increased as indicated by the fibrin degradation products on postoperative day 1. A promoted hemostasis attributable to endothelial activation was in dicated by the increase in von Willebrand factor on postoperative day 1. Pl atelets counts and platelet activation (beta-thromboglobulin) remained at b aseline levels after the operation No adverse clinical events occurred. Conclusions. Patients undergoing off-pump coronary operation show an increa sed procoagulant activity in the first postoperative 24 hours regardless of the surgical approach (midline sternotomy or anterolateral thoracotomy). T his procoagulant activity is not mediated by platelet-related factors. Ther efore, a specific perioperative prophylactic pharmacologic regimen is advis able. (Ann Thorac Surg 1999;67:1370-5) (C) 1999 by The Society of Thoracic Surgeons.