Biphasic pro-thrombotic and inflammatory responses after coronary artery bypass surgery

被引:33
作者
Li, N [1 ]
Astudillo, R
Ivert, T
Hjemdahl, P
机构
[1] Karolinska Hosp, Div Clin Pharmacol, Dept Med, S-17176 Stockholm, Sweden
[2] Karolinska Hosp, Dept Thorac Surg, S-17176 Stockholm, Sweden
关键词
coronary artery bypass grafting; inflammation; leukocytes; platelets; thrombosis;
D O I
10.1046/j.1538-7836.2003.00109.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Early graft failure after coronary artery bypass grafting (CABG) is related to thrombosis and inflammation in the grafted vessel(s). The time courses of, and relationships between, pro-thrombotic and inflammatory responses to CABG surgery have, however, not been well defined. Fifteen patients undergoing CABG were examined before, and 1 h, 1 day, 7 days, and 3 months after surgery. Cellular markers of platelet and leukocyte activation were monitored by whole blood flow cytometry, and plasma markers of pro-thrombotic and inflammatory responses were analyzed by immunoassays. CABG immediately increased circulating P-selectin-positive platelets, leukocyte CD11b expression, and platelet-leukocyte aggregates (PLAs). Thrombin generation (F1 + 2 levels) and cytokine release [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-8, and IL-10], soluble P-selectin, and soluble E-selectin also increased immediately. These alterations persisted during the first week after surgery, with re-bound increases of circulating activated platelets and PLAs, TNF-alpha, and F1 + 2 on day 7. Platelet and PLA responsiveness to in vitro stimulation was suppressed immediately after CABG, but markedly enhanced I week after surgery. After 3 months, plasma soluble P-selectin, F1 + 2, and IL- 10, and monocyte CD11b expression were still slightly elevated compared with baseline. In conclusion, CABG induces marked pro-thrombotic and inflammatory responses, which persist for at least I week. Platelet activation, platelet reactivity, PLA formation, thrombin generation, and TNF-alpha release show a second peak I week after surgery. These findings suggest that intensified and prolonged antithrombotic/inflammatory treatment should be considered after CABG surgery.
引用
收藏
页码:470 / 476
页数:7
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