Induction of monocyte tissue factor procoagulant activity during coronary artery bypass surgery is reduced with heparin‐coated extracorporeal circuit

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Abstract
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 (PPP< 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.

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