Multi-factor Analysis Of Coagulative Disfunction After Coronary Artery Bypass Grafting

Object In recent years, off-pump coronary artery bypass surgery is widely applied in the surgical treatment of coronary heart disease, but Postoperative vascular patency of the graft (especially the vein graft) has been a major area of concern, some report in the literature the vein graft clogging rate is about15-20%in the first year, Restenosis after sugery can improve significantly the rate of secondary revascularization and long-term mortality of patients. The vascular stenosis is one of the main factors for patients prognosis after CABG surgery. Early postoperative bridge clogged is related with arterial and venous thrombus formation in patients who have riecived coronary artery bypass grafts, thrombosis associat with changes of perioperative coagulation, so the detection of perioperative coagulation becomes necessary to analyze the changes in the coagulation, This experiment analysis changes of coagulation function by detecting factor of FVII, vWF, PAI-1, D-dimer, and analyze the impact of various factors on the coagulation, then we select the treatment programs of postoperative anticoagulant, antiplatelet.Method:we first conduct preliminary experiments before the formal test.We select the30patients,20males,10females; average age (61.3±8.2) years; in this experiment. F VII, vWF, PAI-1, D-dimer were obtained and tested on preoperative and postoperative1,4,7,14d blood testing, and we analyze four coagulation trend. Official test method is selected according to the results of preliminary experiments. We retrospectively investigated120patients with OPCAB,Antiplatelet medicine has been ceased for5-7days before surgery, Aspirin was taken6hours after the operation. Low molecular weight heparin (LMWH) was given the first day after operation, male75, female45; FVII, vWF, PAI-1, D-dimer were detected on preoperative and postoperative4,14d, and record D-dimer levels in the postoperative1month2months3months. We also record the clinical data of the patient in the perioperative days. Such as age, body mass index, diabetes, coronary artery disease index, operative time, intraoperative former ACT, the intraoperative heparin-protamine usage, plasma usage, anticoagulation time, and analysis of changes in four coagulation. We select the D-dimer values in the1st month to conduct logistic regression analysis. Result:FVII reduce on4th day (87.64±10.11)%compared with the preoperative (97.70±16.13)%and recovery to (95.70±12.65)%on the postoperative14th day. vWF and PAI-1increased significantly on the4th day after operation [(329.41±106.97)%,(4.95±2.06)U/ml, P＜0.05]. They decreased to baseline on the14th post-operative day[(225.57±89.46)%,(1.88±0.93U/mL)]. The level of D-dimer increased after OPCAB. Until1month after surgerying, it reached the top (2839.76±1382.72μg/L).3months after operation(370.3±260.2μg/L), D-dimer went back to baseline. Various influencing factors such as age, body mass index, diabetes, counts of coronary artery bypass, the ACT before the surgery, the intraoperative heparin-protamine usage, plasma usage has no correlation with the D-dimer in1st month after surgery. The time of using low molecular weight heparin after less than seven days after surgery is an independent factors for impacting on the levels of D-dimer after1month, PAI-1, vWF has no correlation with each factor.Conclusion:A certain degree of coagulation, fibrinolytic state are existing for OPCAB patients in the short time. Anticoagulation, antiplatelet therapy helps to improve the patient hypercoagulable state,and have some effect for surgical outcomes and long-term graft patency.