Tissue Factor Is Rapidly Elevated in Plasma Collected from the Pericardial Cavity during Cardiopulmonary Bypass

Helen Philippou; Antonella Adami; Simon J. Davidson; John R. Pepper; John F. Burman; David A. Lane

doi:10.1055/s-0037-1613979

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2000; 84(01): 124-128
DOI: 10.1055/s-0037-1613979

Commentary

Schattauer GmbH

Tissue Factor Is Rapidly Elevated in Plasma Collected from the Pericardial Cavity during Cardiopulmonary Bypass

Helen Philippou

¹From the Department of Haematology, Imperial College School of Medicine, Charing Cross Hospital Campus, and the Royal Brompton Hospital, London, UK

,

Antonella Adami

¹From the Department of Haematology, Imperial College School of Medicine, Charing Cross Hospital Campus, and the Royal Brompton Hospital, London, UK

,

Simon J. Davidson

¹From the Department of Haematology, Imperial College School of Medicine, Charing Cross Hospital Campus, and the Royal Brompton Hospital, London, UK

,

John R. Pepper

¹From the Department of Haematology, Imperial College School of Medicine, Charing Cross Hospital Campus, and the Royal Brompton Hospital, London, UK

,

John F. Burman

¹From the Department of Haematology, Imperial College School of Medicine, Charing Cross Hospital Campus, and the Royal Brompton Hospital, London, UK

,

David A. Lane

¹From the Department of Haematology, Imperial College School of Medicine, Charing Cross Hospital Campus, and the Royal Brompton Hospital, London, UK

› Institutsangaben

Abstract

Summary

There is growing evidence that the tissue factor/factor VIIa pathway of coagulation is enhanced during cardiopulmonary bypass. Hitherto, available evidence has suggested that upregulated monocyte bound tissue factor is made available, either in the blood collected from the site of surgery or on circulating cells. However, cellular upregulation is slow, while generation of factor VIIa in blood collected from the pericardial cavity is rapid. We have therefore investigated the possibility of an alternative source of tissue factor, plasma (as opposed to cellular) tissue factor in blood samples taken from the central vein catheter (systemic circulation) and collected from the pericardial cavity during cardiopulmonary bypass. Six patients undergoing first time cardiopulmonary bypass grafting were studied. Tissue factor antigen was found to be rapidly elevated (by 15 min) in the pericardial plasma, ∼5-fold above systemic levels (p <0.004). Similar elevations were found in markers of coagulation activation, factor VIIa antigen (p = 0.066), prothrombin fragment F₁₊₂ (p <0.003) and thrombin-antithrombin complex (p <0.03). To explore whether plasma tissue factor was (or had been) functionally active, factor VIIa was measured also with the soluble tissue factor functional assay after removal of heparin. Functional factor VIIa activity fell significantly in the systemic circulation, probably due to the heparin-induced increase (∼15-fold) in tissue factor pathway inhibitor (TFPI), but was elevated in pericardial blood compared with that taken from the central line catheter (p <0.006). These results demonstrate that both components of the activation complex for the extrinsic pathway of coagulation are rapidly generated in pericardial blood during bypass.

Keywords

Tissue factor - factor VIIa - cardiopulmonary bypass - tissue factor pathway inhibitor - heparin

Volltext

Referenzen

References
1 Davies GC, Sobel M, Salzman EW. Elevated plasma fibrinopeptide A and thromboxane B2 levels during cardiopulmonary bypass. Circulation 1980; 61: 808-14.
2 Boisclair MD, Lane DA, Philippou H, Sheikh S, Hunt B. Thrombin production, inactivation and expression during open heart surgery measured by assays for activation fragments including a new ELISA for prothrombin fragment F₁₊₂ . Thromb Haemost 1993; 70: 253-8.
3 Brister SJ, Ofosu FA, Buchanan MR. Thrombin generation during cardiac surgery: is heparin the ideal anticoagulant?. Thromb Haemost 1993; 70: 259-62.
4 Wachtfogel YT, Harpel PC, Edmunds LH, Colman RW. Formation of C1_sC1-inhibitor, kallikrein-C1-inhibitor, and plasmin- α₂-plasmin-inhibitor complexes during cardiopulmonary bypass. Blood 1989; 73: 468-71.
5 Boisclair MD, Lane DA, Philippou H, Esnouf MP, Sheikh S, Hunt B, Smith KJ. Mechanisms of thrombin generation during surgery and cardiopulmonary bypass. Blood 1993; 82: 3350-7.
6 Burman JF, Chung HI, Lane DA, Philippou H, Adami A, Lincoln JCR. Role of factor XII in thrombin generation and fibrinolysis during cardiopulmonary bypass. Lancet 1994; 344: 1192-3.
7 Tabuchi N, de Haan J, Boonstra PW, van Oeveren W. Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993; 106: 828-33.
8 Chung JH, Gikakis N, Rao AK, Drake TA, Colman RW, Edmunds LH. Pericardial blood activates the extrinsic coagulation pathway during clinical cardiopulmonary bypass. Circulation 1996; 93: 2014-8.
9 Philippou H, Davidson SJ, Mole MT, Pepper JR, Burman JF, Lane DA. Two chain factor VIIa generated in the pericardium during surgery with cardiopulmonary bypass: relationship to increased thrombin generation and to heparin concentration. Atherscl Thromb Vasc Biol 1999; 19 (02) 248-54.
10 Nemerson Y. The tissue factor pathway of blood coagulation. Semin Hematol 1992; 29: 170-6.
11 Rapaport SI, Rao LVM. The tissue factor pathway: how it has become a “Prima Ballerina”. Thromb Haemost 1995; 74: 7-17.
12 Kappelmayer J, Bernabei A, Edmunds H, Edgington TS, Colman RW. Tissue factor is expressed on monocytes during simulated extracorporeal circulation. Circ Res 1993; 72: 1075-81.
13 Philippou H, Adami A, Amersey RA, Stubbs PJ, Lane DA. A novel specific immunoassay for plasma two-chain factor VIIa: investigation of FVIIa levels in normal individuals and in patients with acute coronary syndromes. Blood 1997; 89: 767-75.
14 Morrissey JH, Macik BG, Neuanschwander PF, Comp PC. Quantitation of activated factor VII levels in plasma using a tissue factor mutant selectively deficient in promoting factor VII activation. Blood 1993; 81: 734-44.
15 Philippou H, Adami A, Boisclair MD, Lane DA. An ELISA for factor X activation peptide: application to the investigation of thrombogenesis in cardiopulmonary bypass. Br J Haematol 1995; 90: 432-7.
16 Barstad RM, Ovrum E, Ringdal MA, Oystese R, Hamers MJAG, Veiby OP, Rolfsen T, Stephens RW, Sakariassen KS. Induction of monocyte tissue factor procoagulant activity during coronary artery bypass surgery is reduced with heparin-coated extracorporeal circuit. Brit J Haematol 1996; 94: 517-25.
17 de Haan J, Boonstra PW, Monnink SH, Ebels T, van Oeveren W. Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis. Ann Thorac Surg 1995; 59: 901-7.
18 Edgington TS, Mackman N, Brand K, Ruf W. The structural biology of expression and function of tissue factor. Thromb Haemost 1991; 66: 67-79.
19 Ernofsson M, Thelin S, Siegbahn A. Monocyte tissue factor expression, cell activation, and thrombin formation during cardiopulmonary bypass: a clinical study. J Thorac Cardiovasc Surg 1997; 113: 576-84.
20 Nakamura S, Kamikubo Y, Okajima K, Asakura H, Nakamura K. Plasma tissue factor: its sensitive assay and characterisation. Thromb Haemost 1993; 69: 744 (abstract)
21 Koyama T, Nishida K, Ohdama S, Sawada M, Murakami N, Hirosawa S, Kuriyama R, Matsuzawa K, Hasegawa R, Aoki N. Determination of plasma tissue factor antigen and its clinical significance. Brit J Haematol 1994; 87: 343-7.
22 Suefuji H, Ogawa H, Yasue H, Kaikita K, Soejima H, Motoyama T, Mizuno Y, Oshima S, Saito T, Tsuji I, Kumeda K, Kamikubo Y, Nakamura S. Increased plasma tissue factor levels in acute myocardial infarction. Am Heart J 1997; 134: 253-9.
23 Nieuwland R. Berckmans RJ, Rotteveel-Eijkman RC, Maquelin KN, Roozendaal KJ, Jansen PG, ten Have K, Eijsman L, Hack CE, Sturk A Cell-derived microparticles generated in patients during cardiopulmonary bypass are highly procoagulant. Circulation 1997; 96: 3534-41.
24 Sandset PM, Bendz B. Tissue factor pathway inhibitor: clinical deficiency states. Thromb Haemost 1997; 78: 467-70.