Thrombin in myocardial ischemia-reperfusion during cardiac surgery

Ann Thorac Surg. 2009 Jul;88(1):318-25. doi: 10.1016/j.athoracsur.2008.12.097.


Thrombin is a multifunctional protease with procoagulant, pro-inflammatory, and pro-apoptotic effects. Thrombin has direct potentially adverse effects on the endothelium and on cardiomyocytes, which are independent of its procoagulant effects, and it has emerged as a possible mediator of ischemia-reperfusion injury. Several lines of experimental evidence specifically implicate thrombin to be involved in myocardial ischemia-reperfusion injury. Cardiopulmonary bypass increases thrombin generation progressively, but reperfusion after myocardial ischemia induces an additional distinct and rapid increase in thrombin generation. Clinical studies have shown that thrombin formation during cardiac surgery, especially during myocardial reperfusion, is involved with myocardial damage and impaired hemodynamic recovery. Therefore, strategies to improve thrombin control during cardiopulmonary bypass might be beneficial.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anticoagulants / therapeutic use*
  • Biomarkers / blood
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / methods*
  • Cardiopulmonary Bypass / adverse effects
  • Cardiopulmonary Bypass / methods
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / methods
  • Female
  • Humans
  • Intraoperative Complications / prevention & control
  • Male
  • Myocardial Reperfusion / adverse effects*
  • Myocardial Reperfusion / methods
  • Myocardial Reperfusion Injury / etiology
  • Myocardial Reperfusion Injury / mortality
  • Myocardial Reperfusion Injury / prevention & control*
  • Prognosis
  • Risk Assessment
  • Sensitivity and Specificity
  • Survival Analysis
  • Thrombin / adverse effects*
  • Thrombin / drug effects
  • Thrombin / metabolism
  • Treatment Outcome


  • Anticoagulants
  • Biomarkers
  • Thrombin