Relationship between Hypercoagulability and Mesenteric Ischemia Early after Cardiac Surgery

Background: Cardiac surgery is considered to be a hypercoagulable state with an increased incidence of thromboembolic events. In acute mesenteric ischemia (Me-Is), plasma coagulation markers may have additional diagnostic relevance perioperatively.

Methods: Out of 500 consecutive cardiac surgery patients, 25 patients with hyperinflammatory (IL-6 > 600 ng/L) and metabolic acidosis (lactate > 4 mmol/L) were 1:4 matched to a Me-Is group (n = 5) and a control group (n = 20) retrospectively. Blood samples collected before surgery, on ICU admission, and 12 h after ICU admission were assessed for hemostatic parameters, including functional fibrinogen, D-dimer, thrombin-anti-thrombin complex (TAT), prothrombin fragments 1+2 (F1.2). All samples were also evaluated in thrombin generation assays, and intestinal fatty-acid-binding protein (I-FABP) as a marker for Me-Is.

Results: Baseline levels of hemostatic markers in both groups were similar. TAT levels were significantly increased in the Me-IS group at 12 h after ICU admission, respectively (54.2 ± 10.5 vs. 22.2 ± 12.4 ng/mL, p = 0.010). In contrast, at ICU admission, absolute F1.2 values were significantly increased in the control group (1.19 ± 0.04 vs. 21.1 ± 13.4 ng/mL, p = 0.047). However, the relative F1.2 values of the Me-Is group (394.2 ± 231.6%) versus the control group (114.7 ± 144.9%) within 12 h after ICU admission were 3.9- vs. 1.1-fold higher than baseline, vs. with a significant difference (p = 0.046). Postoperatively, significantly higher levels of I-FABP and of D-Dimers were observed in the Me-Is group, respectively 17116.2 ± 18185.4 vs. 2252.3 ± 1582.7 pg/mL (p = 0.006) and 5.3 ± 1.3 vs. 3.0 ± 2.1 µg/mL (p = 0.043) at ICU admission and 16998.2 ± 20346.3 vs. 1030.8 ± 1100.0 pg/mL (p = 0.030) and 3.7 ± 1.8 vs. 1.2 ± 0.8 µg/mL (p = 0.005) at 12 h after ICU admission compared with the control group. No significant differences were observed for thrombin generation (TGA, peak value, ETP) between both groups.

Conclusion: Our findings suggest that TAT and F1.2 levels are promising candidate markers for evaluating coagulability after cardiac surgery. High levels of activation markers suggest a temporary stage of hypercoagulability immediately after surgery in Me-Is patients.

Publication History

Article published online:
11 February 2025