Cardiopulmonary bypass and activation of antithrombotic plasma protein C

J. Petaja, E. Pesonen, J. A. Fernandez, A. E. Vento, O. J. Ramo, J. H. Griffin, A. M. Schmidt, E. A. Rose, David Stern

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: We hypothesized that antithrombotic plasma-activated protein C plays a defensive antithrombotic role during coronary ischemia and postischemic reperfusion. Methods and results: We evaluated protein C activation during cardiopulmonary bypass and coronary reperfusion in 20 patients undergoing coronary bypass surgery. During cardiopulmonary bypass and during the 10 minutes after aortic unclamping, the plasma levels of protein C (mean ± standard error of the mean) decreased from 123% ± 7% to 74% ± 5% of normal mean. In contrast, the levels of activated protein C in plasma increased from 122% ± 8% to 159% ± 21%, and the activated protein C/protein C ratio increased from 1.04 ± 0.08 to 2.29 ± 0.31 (P = .006, 2- tailed Wilcoxon signed rank test). Patients were stratified on the basis of the increase in activated protein C in the coronary sinus plasma at 10 minutes after reperfusion by means of the arbitrary value of 1.5 for the activated protein C/protein C ratio. Within 24 hours, the patients with low increases in activated protein C (ratio < 1.5, n = 8) had a significantly (P < .05) lower cardiac output and mean pulmonary artery pressure, as well as a higher systemic vascular resistance, than patients (n = 11) with high increases in activated protein C (ratio > 1.5). The rapid increase in activated protein C during the first 10 minutes after aortic unclamping indicated protein C activation in the reperfused vascular beds. Conclusions: the antithrombotic protein C pathway was significantly activated during cardiopulmonary bypass mainly during the minutes after aortic unclamping in the ischemic vascular beds. Suboptimal protein C activation during ischemia may impair the postischemic recovery of human heart and circulation.

Original languageEnglish (US)
Pages (from-to)422-431
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume118
Issue number3
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

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Protein C
Cardiopulmonary Bypass
Blood Proteins
Reperfusion
Blood Vessels
Ischemia
Myocardial Reperfusion
Coronary Sinus
Nonparametric Statistics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiopulmonary bypass and activation of antithrombotic plasma protein C. / Petaja, J.; Pesonen, E.; Fernandez, J. A.; Vento, A. E.; Ramo, O. J.; Griffin, J. H.; Schmidt, A. M.; Rose, E. A.; Stern, David.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 118, No. 3, 01.01.1999, p. 422-431.

Research output: Contribution to journalArticle

Petaja, J, Pesonen, E, Fernandez, JA, Vento, AE, Ramo, OJ, Griffin, JH, Schmidt, AM, Rose, EA & Stern, D 1999, 'Cardiopulmonary bypass and activation of antithrombotic plasma protein C', Journal of Thoracic and Cardiovascular Surgery, vol. 118, no. 3, pp. 422-431. https://doi.org/10.1016/S0022-5223(99)70178-9
Petaja, J. ; Pesonen, E. ; Fernandez, J. A. ; Vento, A. E. ; Ramo, O. J. ; Griffin, J. H. ; Schmidt, A. M. ; Rose, E. A. ; Stern, David. / Cardiopulmonary bypass and activation of antithrombotic plasma protein C. In: Journal of Thoracic and Cardiovascular Surgery. 1999 ; Vol. 118, No. 3. pp. 422-431.
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abstract = "Objective: We hypothesized that antithrombotic plasma-activated protein C plays a defensive antithrombotic role during coronary ischemia and postischemic reperfusion. Methods and results: We evaluated protein C activation during cardiopulmonary bypass and coronary reperfusion in 20 patients undergoing coronary bypass surgery. During cardiopulmonary bypass and during the 10 minutes after aortic unclamping, the plasma levels of protein C (mean ± standard error of the mean) decreased from 123{\%} ± 7{\%} to 74{\%} ± 5{\%} of normal mean. In contrast, the levels of activated protein C in plasma increased from 122{\%} ± 8{\%} to 159{\%} ± 21{\%}, and the activated protein C/protein C ratio increased from 1.04 ± 0.08 to 2.29 ± 0.31 (P = .006, 2- tailed Wilcoxon signed rank test). Patients were stratified on the basis of the increase in activated protein C in the coronary sinus plasma at 10 minutes after reperfusion by means of the arbitrary value of 1.5 for the activated protein C/protein C ratio. Within 24 hours, the patients with low increases in activated protein C (ratio < 1.5, n = 8) had a significantly (P < .05) lower cardiac output and mean pulmonary artery pressure, as well as a higher systemic vascular resistance, than patients (n = 11) with high increases in activated protein C (ratio > 1.5). The rapid increase in activated protein C during the first 10 minutes after aortic unclamping indicated protein C activation in the reperfused vascular beds. Conclusions: the antithrombotic protein C pathway was significantly activated during cardiopulmonary bypass mainly during the minutes after aortic unclamping in the ischemic vascular beds. Suboptimal protein C activation during ischemia may impair the postischemic recovery of human heart and circulation.",
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AU - Pesonen, E.

AU - Fernandez, J. A.

AU - Vento, A. E.

AU - Ramo, O. J.

AU - Griffin, J. H.

AU - Schmidt, A. M.

AU - Rose, E. A.

AU - Stern, David

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N2 - Objective: We hypothesized that antithrombotic plasma-activated protein C plays a defensive antithrombotic role during coronary ischemia and postischemic reperfusion. Methods and results: We evaluated protein C activation during cardiopulmonary bypass and coronary reperfusion in 20 patients undergoing coronary bypass surgery. During cardiopulmonary bypass and during the 10 minutes after aortic unclamping, the plasma levels of protein C (mean ± standard error of the mean) decreased from 123% ± 7% to 74% ± 5% of normal mean. In contrast, the levels of activated protein C in plasma increased from 122% ± 8% to 159% ± 21%, and the activated protein C/protein C ratio increased from 1.04 ± 0.08 to 2.29 ± 0.31 (P = .006, 2- tailed Wilcoxon signed rank test). Patients were stratified on the basis of the increase in activated protein C in the coronary sinus plasma at 10 minutes after reperfusion by means of the arbitrary value of 1.5 for the activated protein C/protein C ratio. Within 24 hours, the patients with low increases in activated protein C (ratio < 1.5, n = 8) had a significantly (P < .05) lower cardiac output and mean pulmonary artery pressure, as well as a higher systemic vascular resistance, than patients (n = 11) with high increases in activated protein C (ratio > 1.5). The rapid increase in activated protein C during the first 10 minutes after aortic unclamping indicated protein C activation in the reperfused vascular beds. Conclusions: the antithrombotic protein C pathway was significantly activated during cardiopulmonary bypass mainly during the minutes after aortic unclamping in the ischemic vascular beds. Suboptimal protein C activation during ischemia may impair the postischemic recovery of human heart and circulation.

AB - Objective: We hypothesized that antithrombotic plasma-activated protein C plays a defensive antithrombotic role during coronary ischemia and postischemic reperfusion. Methods and results: We evaluated protein C activation during cardiopulmonary bypass and coronary reperfusion in 20 patients undergoing coronary bypass surgery. During cardiopulmonary bypass and during the 10 minutes after aortic unclamping, the plasma levels of protein C (mean ± standard error of the mean) decreased from 123% ± 7% to 74% ± 5% of normal mean. In contrast, the levels of activated protein C in plasma increased from 122% ± 8% to 159% ± 21%, and the activated protein C/protein C ratio increased from 1.04 ± 0.08 to 2.29 ± 0.31 (P = .006, 2- tailed Wilcoxon signed rank test). Patients were stratified on the basis of the increase in activated protein C in the coronary sinus plasma at 10 minutes after reperfusion by means of the arbitrary value of 1.5 for the activated protein C/protein C ratio. Within 24 hours, the patients with low increases in activated protein C (ratio < 1.5, n = 8) had a significantly (P < .05) lower cardiac output and mean pulmonary artery pressure, as well as a higher systemic vascular resistance, than patients (n = 11) with high increases in activated protein C (ratio > 1.5). The rapid increase in activated protein C during the first 10 minutes after aortic unclamping indicated protein C activation in the reperfused vascular beds. Conclusions: the antithrombotic protein C pathway was significantly activated during cardiopulmonary bypass mainly during the minutes after aortic unclamping in the ischemic vascular beds. Suboptimal protein C activation during ischemia may impair the postischemic recovery of human heart and circulation.

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