Heparin-coated systems for extracorporeal lung-assist (ECLA) were developed to reduce hemorrhagic risk by lowering the systemic heparinization, monitored by global tests, e.g. activated coagulation time (ACT) and activated partial thromboplastin time (APTT). Since this strategy gives no insight into procoagulant states, five ARDS patients receiving ECLA with heparin-coated systems were investivated for changes in coagulation using both global and extended tests. During ECLA onset the APTT and ACT were within or near normal ranges, platelets decreased 76.5% within 48h, fibrinogen decreased 28.7%, thrombin-antithrombin-III complexes were elevated before ECLA (53 μg/L), but demonstrated an additional peak (238 μg/L), plasminogen-activator-inhibitor-1 increased 12-fold, and the C1-inhibitor dropped 14.1%. In conclusion, after the onset of ECLA from a previous prethrombotic state, the precoagulant, anticoagulant, fibrinolytic and complement systems were activated in a similar way to that reported for non-heparinized systems with high-dose heparin. This was however only monitored by an extended test panel which was unable to predict thromboembolic events during ECLA.
AndersonHL3rd, ShapiroM.B., DeliusR.E., SteimleC.N., ChapmanR.A., BartlettR.H.. Extracorporeal life support for respiratory failure after multiple trauma.J Trauma1994; 37: 266–72.
2.
GattinoniL., PesentiA., BombinoM., PelosiP., BrazziL.. Role of extracorporeal circulation in adult respiratory distress syndrome management.New Horizons1993; 1: 603–12.
3.
GattinoniL., PesentiA., MascheroniD.. Low frequency positive pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure.JAMA1986; 256: 881–6.
4.
ZapolW.M., SniderM.T., HillJ.D.. Extracrporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective studie.JAMA1979; 242: 2193–6.
UzielL., CugnoM., FabriziI., PesentiA., GattinoniL., AgostoniA.. Physiopathology and management of coagulation during long-term extracorporeal respiratory assistance.Int J Artif Organs1990; 13: 280–7.
7.
PetersJ., RadermacherP., KuntzM.E.. Extracorporeal CO2-removal with a heparin coated artificial lung.Intensive Care Med1988; 14: 578–84.
8.
WendelH.P., HellerW., GallimoreM.J., HoffmeisterH.E.. Heparin-coated oxygenators significantly reduce contact system activation in an in vitro cardiopulmonary bypass model.Blood Coagulation and Fibrinolyisis,1994; 5: 673–8.
9.
SvennevigJ.I., GeiranO.R., KarlsenH.. Complement activation during extracorporeal circulation. In vitro comparison of Duraflo II heparin-coated and uncoated oxygenator circuits.J Thorac Cardiovasc Surg1993; 106: 466–72.
10.
KodamaK., PascheB., OlssonP.. AT III binding to surface immobilized heparin and its relation to F Xa inhibition.Thromb Haemostas1987; 58: 1064–7.
11.
PascheB., KodamaK., LarmO., OlssonP., SwedenborgJ.. Thrombin inactivation on surfaces with covalently bonded heparin.Thrombos Res1986; 44: 739–48.
12.
LarmO., LarssonR., OlssonP.. A new non-thrombogenic surface prepared by selective covalent binding of heparin via a modified reducing terminal residue.Biomat Med Dev Art Org1983; 11: 161–73.
13.
MottaghyK., OedekovenB., PöppelK.. Heparin-coated versus non-coated surfaces for extracorporeal circulation.Int J Artif Organs1991; 14: 721–8.
14.
KirschfinkM., KovacsB., MottaghyK.. Extracorporeal circulation: in vivo and in vitro analysis of complement activation by heparin-bonded surfaces.Circ Shock1993; 40: 221–6.
15.
ShanleyC.J., HultquistK.A., RosenbergD.M., McKenzieJm, ShahN.L., BartlettR.H.. Prolonged extracorporeal circulation without heparin. Evaluation of the Medtronic Minimax oxygenator.ASAIO J1992; 38: M311–6.
BindslevL., GoudaI., InacioJ.. Extracorporeal elimination of carbon dioxide using a surface-heparinized veno-venous bypass system.ASAIO Trans1986; 32: 530–3.
18.
WillmsD., DembitskyW.. Prolonged extracorporeal support for ARDS using surface-heparinized equipment.Chest1992; 102: 968–70.
19.
KnochM., KollenB., DietrichG.. Progress in veno-venous long-term bypass techniques for the treatment of ARDS. Controlled clinical trial with the heparin-coated bypass circuit.Int J Artif Organs1992; 15: 103–8.
RossainlR., SlamaK., LewandowskiK.. Major thoracic surgery during long-term extracorporeal lung assist for treatment of severe adult respiratory distress syndrome (ARDS).Eur J Cardiothorac Surg1992; 6: 43–5.
22.
BindslevL., BohmC., JolinA., Hambraeus-JonzonK., OlssonP., RyniakS.. Extracorporeal CO2 removal performed with surface-heparinized equipment in patients with ARDS.Acta Anaesthesiol Scand1991; 95(suppl): 125–30.
23.
BindslevL., EkludJ., NorlanderO.. Treatment of acute respiratory failure by extracorporeal carbon dioxide elimination performed with a surface heparinized artificial lung.Anes-the-siol1987; 67: 117–20.
24.
PlotzF.B., van OeverenW., BartlettR.H.. Blood activation during neonatal extracorporeal life support.J Thorac Cardiovasc Surg1993; 105: 823–32.
25.
van der KampKWHJ, van OeverenW.. Contact, coagulation and platelet interaction with heparin treated equipment during heart surgery.Int J Artif Organs1993; 16: 836–42.
26.
BickR.L.. The clinical significance of fibrinogen degradation products.Semin Thromb Hemost1983; 8: 302–30.
27.
SteinbergJ.B., KapelanskiD.P., OlsonJ.D., WeilerJ.M.. Cytokine and complement levels in patients undergoing cardiopulmonary bypass.J Thorac Cardiovasc Surg1993; 106: 1008–16.
28.
FurieB., FurieB.C.. Molecular and cellular biology of blood coagulation.N Engl J Med1992; 326: 800–6.
29.
WebbA.R., MythenM.G., JacobsonD., MackieI.J.. Maintaining blood flow in the extracorporeal circuit: hemostasis and anticoagulation.Intensive Care Med1995; 21: 84–93.
30.
RinderC.S., GaalD., StudentL.A., SmithB.R.. Platelet-leukocyte activation and modulation of adhesion receptors in pediatric patients with congenital heart disease undergoing cardiopulmonary bypass.J Thorac Cardiovasc Surg1994; 107: 208–8.
31.
GravleeG.P., WhitakerC.L., MarkL.J., RogersA.T., RoysterR., HarrisonG.A.. Baseline activated coagulation time should be measured after surgical incision.Anesth Analg1990; 71: 549–53.
32.
BooksteinJ.J., ArunK.. Experimental investigation of hyper-coagulant conditions associated with angiography.J Vasc Interv Radiol1995; 6: 197–204.
33.
DaugschiesA., AltfeldE., RommelM.. Hemostatic alterations in pigs fed sublethal doses of Sarcocystis miescheriana.Vet Parasitol1989; 34: 1–13.
34.
DingA.W., WuH., KongL.D.. Research on hemostatic mechanism of extracts from carbonized Schizonepeta tenuifolia Brig.Chung Kuo Chung Yao Tsa Chih1993; 18: 598–600.
35.
OlivieriO., FrisoS., ManzatoF.. Resistance to activated protein C in healthy women taking oral contraceptives.Br J Haematol1995; 91: 465–70.
36.
FukutomiT., NanasawaT., YanamotoH., AdachiI., WatanabeT.. The induction of a hypercoagulable state by medroxyprogesterone acetate in breast cancer patients; Jpn J Surg1990; 20: 665–70.
37.
FuruiH., TaniguchiN., YamauchiK., SotobataI., SaitoH., InagakiH.. Effects of treadmill exercise on platelet function, blood coagulability and fibrinolytic activity in patients with atrial fibrillation.Jpn Heart J1987; 28: 177–84.
38.
BraudeS., NolopK., FlemingJ., KrauszT., TaylorK., RoystonD.. Increased pulmonary transvascular protein flux after canine cardiopulmonary bypass: association with lung neutrophil sequestration and tissue peroxidation.Am Rev Respir Dis1986; 123: 867–71.
