Unchanged Coagulation Activation Despite Intraoperative Cytokine Removal in Cardiac Surgery

All articles of this category (opens in new window) Background: Postoperative hypercoagulability is a well-established phenomenon following cardiac surgery, driven by surgical trauma, systemic inflammation, and cardiopulmonary bypass (CPB). Adsorptive therapies such as hemoadsorption have been supposed to attenuate these responses, but their effects on plasmatic coagulation activation and thrombin generation remain unclear. Methods: In this prospective, randomized controlled trial, 50 adult patients undergoing elective cardiac surgery with CPB were randomized to intraoperative hemoadsorption treatment ( n = 25) or standard of care ( n = 25). Blood samples were collected at baseline (T0), after CPB (T3), 8 hours after CPB (T5), and 24 hours after CPB (T6). Coagulation markers (prothrombin fragments F1.2, thrombin–antithrombin [TAT] complexes, antithrombin III, fibrinogen, D-dimer) and thrombin generation parameters (lag time, time to peak, peak height, velocity index, endogenous thrombin potential) were analyzed. Results: Baseline characteristics and conventional coagulation tests were comparable between groups. Across both groups, thrombin generation parameters showed significant temporal changes: AUC, Peak, and Velocity Index decreased from T0 to T6, while lag time and time to peak were prolonged (all p < 0.05). F1.2 and TAT increased significantly from T0 to T3 and remained elevated at T5. Slope analyses confirmed consistent within-group trends. Between-group comparisons revealed only isolated differences, such as a transient difference in lag time at T3 ( p = 0.041), without consistent divergence between hemoadsorption and Control patients. Conclusion: Cardiac surgery with CPB induces marked and parallel changes in thrombin generation and clot dynamics, irrespective of hemoadsorption treatment. Adsorptive therapy did not modify the trajectory of plasmatic coagulation activation. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany