Altered plasma antigen levels of tissue factor pathway inhibitor during open-heart surgery.

Tissue factor pathway inhibitor (TFPI) is a potent inhibitor of the extrinsic pathway of the coagulation cascade that is activated by cardiopulmonary bypass (CPB) during open-heart surgery. In the present study, we investigated whether the plasma TFPI antigen increases during CPB in 12 patients who underwent bypass procedures. The plasma levels of free and total TFPI antigens were measured using an enzyme-linked immunosorbent assay, and heparin concentrations were measured using a chromogenic substrate assay. We found that changes in the total plasma TFPI antigen level were significantly dependent on the level of free TFPI antigen (r = 0.96, P < 0.0001) which increased significantly after heparin injection (P < 0.0001), and increased further during the bypass period (P < 0.005). The increased free TFPI antigen level during CPB correlated with the duration of bypass (r = 0.65, P = 0.02). When heparin was neutralized by protamine, the free TFPI antigen level decreased immediately, but remained higher than the preoperative level (P < 0.005). These results suggest that plasma TFPI antigen levels increase during CPB.