Download PDF
Thromb Haemost 1978; 39(02): 474-487
DOI: 10.1055/s-0038-1646707
Original Article
Schattauer GmbH Stuttgart

The Hemostatic Mechanism after Open-Heart Surgery

III. Correlation between the Appearance of an Abnormal Protein Demonstrated by Gel Electrophoresis and of an Inhibitor of the Extrinsic Coagulation System (PEC)
E R Cole
The Rush-Presbyterian-St. Luke’s Medical Center, Coagulation Laboratories, Hematology Section, Department of Medicine, Chicago, Illinois, U.S.A.
,
F Bachmann
The Rush-Presbyterian-St. Luke’s Medical Center, Coagulation Laboratories, Hematology Section, Department of Medicine, Chicago, Illinois, U.S.A.
,
C A Curry
The Rush-Presbyterian-St. Luke’s Medical Center, Coagulation Laboratories, Hematology Section, Department of Medicine, Chicago, Illinois, U.S.A.
,
D Roby
The Rush-Presbyterian-St. Luke’s Medical Center, Coagulation Laboratories, Hematology Section, Department of Medicine, Chicago, Illinois, U.S.A.
› Author Affiliations
Further Information

Publication History

Received 28 October 1977

Accepted 13 September 1977

Publication Date:
26 July 2018 (online)

Also available at
  PDF Download  Permissions and Reprints

Summary

A prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

 

  • References

  • 1 Bachmann F, Mckenna R, Cole E. et al 1975; The hemostatic mechanism after open-heart surgery. I. Studies on plasma coagulation factors and fibrinolysis in 512 patients after extracorporeal circulation. Journal of Thoracic and Cardiovascular Surgery 70: 76
    PubMedSearch in Google Scholar
  • 2 Biggs R, Macfarlane RG. 1962. Human Blood Coagulation and its Disorders. 3rd. FA Davis Company; Philadelphia: 370
    Search in Google Scholar
  • 3 Cesbron N, Boyer C, Guillin MC. et al 1973; Human coumarin prothrombin: chromatographic, coagulation and immunologic studies. Thrombosis et Diathesis Haemorrhagica 30: 437
    PubMedSearch in Google Scholar
  • 4 Davis BJ. 1964; Disc electrophoresis. II. Method and application to human serum proteins. Annals of the New York Academy of Sciences 121: 404
    PubMedSearch in Google Scholar
  • 5 Denson KWE, Borrett R, Biggs R. 1971; The specific assay of prothrombin using the Taipan snake venom. British Journal of Haematology 21: 219
    CrossrefPubMedSearch in Google Scholar
  • 6 Ganrot PO, NiléHN JE. 1968; Plasma prothrombin during treatment with dicumarol. II. Demonstration of an abnormal prothrombin fraction. Scandinavian Journal of Clinical and Laboratory Investigation 22: 23
    PubMedSearch in Google Scholar
  • 7 Ganrot PO, NiléHN JE. 1971; Biosynthesis of an abnormal prothrombin in malnutrition and biliary obstruction and during dicumarol treatment. Scandinavian Journal of Clinical and Laboratory Investigation 28: 245
    CrossrefPubMedSearch in Google Scholar
  • 8 Girardot JM, Delaney R, Johnson BC. 1974; Carboxylation, the completion step in prothrombin biosynthesis. Biochemical and Biophysical Research Communications 59: 1197
    CrossrefPubMedSearch in Google Scholar
  • 9 Hemker HC, Veltkamp JJ, Hensen A. et al 1963; Nature of prothrombin biosynthesis: Pre-prothrombinaemia in vitamin K deficiency. Nature 200: 589
    CrossrefPubMedSearch in Google Scholar
  • 10 Hemker HC, Veltkamp JJ, Loeliger EA. 1968; Kinetic aspects of the interaction of bloodclotting enzymes. III. Demonstration of an inhibitor of prothrombin conversion in vitamin K deficiency. Thrombosis et Diathesis Haemorrhagica 19: 1346
    PubMedSearch in Google Scholar
  • 11 Johnson HV, Boyd C, Martinovic J. et al 1972; A new blood protein which increases with vitamin K deficiency. Archives of Biochemistry and Biophysics 148: 431
    CrossrefPubMedSearch in Google Scholar
  • 12 Josso F, Lavergne JM, Gouault M. et al 1968; Différents états moléculaires du facteur II (Prothrombine). Leur étude a l’aide de la staphylocoagulase et d’anticorps anti-facteur II. I. Le facteur II chez les sujets traités par les antagonistes de la vitamine K. Thrombosis et Diathesis Haemorrhagica 20: 88
    PubMedSearch in Google Scholar
  • 13 Loeliger EA, Meuwisse-BRAUN JB, Muis H. et al 1970; Laboratory control of oral anticoagulants. Definition of therapeutic range in terms of different thromboplastin preparations. Thrombosis et Diathesis Haemorrhagica 23: 569
    PubMedSearch in Google Scholar
  • 14 Malhotra OP. 1972; Atypical prothrombin in purified preparations from dicoumarol-treated steers. Life Sciences 11: 901
    CrossrefPubMedSearch in Google Scholar
  • 15 Nelsestuen GL, Zytkovicz TH, Howard JB. 1974; a The mode of action of vitamin K. The Journal of Biological Chemistry 249: 6347
    PubMedSearch in Google Scholar
  • 16 Nelsestuen GL, Zytkovicz TH, Howard JB. 1974; b γ-Carboxyglutamic acid: Identification and distribution in vitamin K-dependent proteins Mayo Clinic Proceedings. 49: 941
    PubMedSearch in Google Scholar
  • 17 Oliver D, Chalkley R. 1971; An improved photographic system for polyacrylamide gels. Analytical Biochemistry 44: 540
    CrossrefPubMedSearch in Google Scholar
  • 18 Poller L, Thomson J. 1969. The Manchester comparative reagent. A national reference standard for anticoagulant therapy. In: Human Blood Coagulation: Biochemistry, Clinical Investigation and Therapy. Springer-Verlag; New York: 294
    Search in Google Scholar
  • 19 Stenflo J. 1970; Dicumarol-induced prothrombin in bovine plasma. Acta Chemica Scandinavica 24: 3762
    CrossrefPubMedSearch in Google Scholar
  • 20 Stenflo J, Fernlund P, Egan W. et al 1974; Vitamin K-dependent modifications of glutamic acid residues in prothrombin. Proceedings of the National Academy of Sciences, USA 71: 2730
    CrossrefPubMedSearch in Google Scholar
  • 21 Swart ACW, Klaassen BHM, Bloys-Vantreslond-Degroot CHF. et al 1972; The adsorption of blood coagulation factors II, VII, IX and X from human plasma to aluminium hydroxide. Thrombosis et Diathesis Haemorrhagica 27: 490
    PubMedSearch in Google Scholar