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Induction of monocyte tissue factor procoagulant activity during coronary artery bypass surgery is reduced with heparin‐coated extracorporeal circuit
Author(s) -
Barstad R. Marius,
ØVrum Eivind,
Ringdal MariAnne L.,
ØYstese Rolf,
Hamers Maria J. A. G.,
Veiby Ole P.,
Rolfsen Torill,
Stephens Ross W.,
Sakariassen Kjell S.
Publication year - 1996
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1996.tb08989.x
Subject(s) - oxygenator , extracorporeal , heparin , cardiopulmonary bypass , tissue factor , medicine , monocyte , extracorporeal circulation , anesthesia , coagulation , pharmacology
Summary. The possible activation of monocytes to express tissue factor procoagulant activity (TF‐PCA) during CPB (cardiopulmonary bypass) was investigated. 22 patients undergoing myocardial revascularization were randomly assigned to two groups. In group C, heparin‐coated circuits (Duraflo II) and reduced systemic heparinization (ACT > 250 s) were used. In group NC, non‐coated circuits and standard heparin administration (ACT > 480 s) were used. Adherent monocytes retrieved from the oxygenators immediately after bypass arrest showed a 2–3‐fold increase in TF‐PCA when compared to circulating cells pre‐CPB ( P < 0·01). When cell PCA was expressed as percent change from pre‐CPB (baseline) values, circulating monocytes in group NC at CPB‐arrest showed a 2‐fold increase in PCA compared to group C ( P <0·05). Moreover, the percent increase in PCA of oxygenator‐retrieved monocytes was 7‐fold in group NC and 2‐fold in group C ( P <0·008 and P < 0·004, respectively). Thus, heparin‐coating of the extracorporeal circuit reduced induction of adherent cell TF‐PCA by 70% ( P <0·05). Thus, monocyte TF‐PCA may cause activation of the extrinsic coagulation pathway during CPB surgery. It is apparent that heparin‐coating enhanced biocompatibility of extracorporeal circuits. Reduced systemic heparinization in group C proved to be safe. However, further reduction of heparin administration may not be advisable, since monocytes were still activated in the coated oxygenator.