Activation of protein C and hemodynamic recovery after coronary artery bypass surgery

Changes in levels of activated protein C (APC; panels A and B), prothrombin fragment F1+2 (panel A),¹⁰ soluble fibrin monomer complexes (panel B), and ratios of APC to F1+2 (APC/F1+2; panel C) and soluble fibrin monomer complexes to F1+2 (panel C). The mean preoperative ratios were arbitrarily adjusted to 1.0 to better illustrate their differential kinetics. Time points measured are preoperatively (A), at 15 minutes of CPB (B), immediately before the release of the aortic clamp (C), 15 minutes after the release of the aortic clamp (D), 30 minutes (E) and 6 hours (F) after protamine administration, and on the first (G) and fifth (H) postoperative days. The time scale reflects actual time between time points A through F. Time points G and H are not in scale. Values are presented as means ± standard error of the mean.

Cardiac index of patients with preoperative activated protein C to protein C ratio (APC/PC) in the highest decile versus others. Time points measured are preoperatively (A), after termination of cardiopulmonary bypass (E), postoperatively on arrival in the intensive care unit (ICU), 6 hours after protamine administration (F), and on the first postoperative day (G). The time scale reflects actual time between time points A through F. Time point G is not in scale. *Repeated-measures analysis of variance: P < .05 between groups. Values are presented as means ± standard error of the mean.

Cardiac index of patients with activated protein C (APC) levels in the highest quintile before the release of the aortic clamp (time point C) versus others. Time points measured are preoperatively (A), after termination of cardiopulmonary bypass (E), postoperatively on arrival in the intensive care unit (ICU), 6 hours after protamine administration (F), and on the first postoperative day (G). The time scale reflects actual time between time points A through F. Time point G is not in scale. *Repeated-measures analysis of variance: P < .05 between groups. Values are presented as means ± standard error of the mean.

Stroke volume index of patients with activated protein C (APC) levels in the highest decile after heparin neutralization (time point E) versus others. Time points measured are preoperatively (A), after termination of cardiopulmonary bypass (E), postoperatively on arrival in the intensive care unit (ICU), 6 hours after protamine administration (F), and on the first postoperative day (G). The time scale reflects actual time between time points A through F. Time point G is not in scale. *Repeated-measures analysis of variance: P < .05 between groups. Values are presented as means ± standard error of the mean.