Higher Preoperative Plasma Thrombin Potential in Patients Undergoing Surgery for Aortic Stenosis Compared to Surgery for Stable Coronary Artery Disease.

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  • Author(s): Dimberg A;Dimberg A; Alström U; Alström U; Ståhle E; Ståhle E; Christersson C; Christersson C
  • Source:
    Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis [Clin Appl Thromb Hemost] 2018 Nov; Vol. 24 (8), pp. 1282-1290. Date of Electronic Publication: 2018 May 16.
  • Publication Type:
    Comparative Study; Journal Article; Observational Study
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Sage Publications Country of Publication: United States NLM ID: 9508125 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-2723 (Electronic) Linking ISSN: 10760296 NLM ISO Abbreviation: Clin Appl Thromb Hemost Subsets: MEDLINE
    • Publication Information:
      Publication: Thousand Oaks, CA : Sage Publications
      Original Publication: New York, N.Y. : Raven Press, c1995-
    • Subject Terms:
      Aortic Valve Stenosis*/blood ; Aortic Valve Stenosis*/surgery ; Coronary Artery Disease*/blood ; Coronary Artery Disease*/surgery ; Preoperative Care* ; Thrombelastography*; Thrombin/*metabolism; Aged ; Female ; Humans ; Male ; Middle Aged
    • Abstract:
      Aortic stenosis (AS) and coronary artery disease (CAD) influence the coagulation system, potentially affecting hemostasis during cardiac surgery. Our aim was to evaluate 2 preoperative global hemostasis assays, plasma thrombin potential and thromboelastometry, in patients with severe aortic valve stenosis compared to patients with CAD. A secondary aim was to test whether the assays were associated with postoperative bleeding. Calibrated automated thrombogram (CAT) in platelet-poor plasma and rotational thromboelastometry (ROTEM) in whole blood were analyzed in patients scheduled for elective surgery due to severe AS (n = 103) and stable CAD (n = 68). Patients with AS displayed higher plasma thrombin potential, both thrombin peak with median 252 nmol/L (interquartile range 187-319) and endogenous thrombin potential (ETP) with median 1552 nmol/L/min (interquartile range 1340-1838), when compared to patients with CAD where thrombin peak was median 174 nmol/L (interquartile range 147-229) and ETP median 1247 nmol/L/min (interquartile range 1034-1448; both P < .001). Differences persisted after adjustment for age, gender, comorbidity, and antithrombotic treatment. Differences observed in thromboelastometry between the groups did not persist after adjustment for baseline characteristics. Bleeding amount showed no relationship with plasma thrombin potential but weakly to thromboelastometry ( R 2 = .064, P = .001). Patients with AS exhibited preoperatively increased plasma thrombin potential compared to patients with CAD. Plasma thrombin potential was not predictive for postoperative bleeding in patients scheduled for elective surgery.
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    • Contributed Indexing:
      Keywords: bleeding; hemostasis; in vitro diagnostic systems
    • Accession Number:
      EC 3.4.21.5 (Thrombin)
    • Publication Date:
      Date Created: 20180518 Date Completed: 20181211 Latest Revision: 20200225
    • Publication Date:
      20231215
    • Accession Number:
      PMC6714769
    • Accession Number:
      10.1177/1076029618776374
    • Accession Number:
      29768939