The effects of intermittent prebypass heparin dosing in patients undergoing coronary artery bypass grafting

Abstract

In this study, 10 patients (Group B) were given three consecutive prebypass doses of heparin (100 IU/kg) with a 4 min interval prior to cardiopulmonary bypass (CPB) institution. They were compared with 10 patients (Group A) receiving the standard single prebypass heparin dose (300 IU/kg). The haemostatic response and anticoagulant monitoring during the perioperative period were investigated by point-of-care and several coagulation tests. Results of both groups were also correlated to blood loss. Three patients in Group B required additional heparin during bypass as compared with six patients in Group A. This suggests that intermittent prebypass heparin dosing is more effective in maintaining adequate levels of anticoagulation during CPB. Group B had a lower mean decrease in factor VIII (13.9% versus 43.2%), fibrinogen (38.5% versus 46.6%), antithrombin III (34.7% versus 40.1%) and platelet count (23.2% versus 28.9%) during bypass while only one unit of red cell concentrate was required postoperatively as compared with four units in Group A. In one patient, high fibrinolytic assays were associated with a haemorrhagic pericardial effusion occurring beyond 24 hours postsurgery.

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References

Keck WM. Center for Transgene Research. Haemostasis - introduction and goals. Retrieved 17th October 2002, from http://www.nd.edu/%7Etransgen/research/hemostasis.html

Hirsh J , Warkentin TE , Shaughnessy, SG et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety . Chest 2001; 119: S64-S94 .

Heimark RL , Kurachi K , Fujikawa K , Davie EW. Surface activation of blood coagulation, fibrinolysis and kinin formation . Nature 1980; 286: 456-460 .

Johnell M , Elgue G , Larsson R , Larsson A , Thelin S , Siegbahn MH. Coagulation, fibrinolysis and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface . J Thorac Cardiovasc Surg 2002; 124: 321-332 .

Bull MH , Huse WM , Bull BS. Evaluation of tests used to monitor heparin therapy during extracorporeal circuit . Anesthesiology 1975; 43: 346-354 .

Brinks HJ , Weerwind PW , Bogdan S , Verbruggen H , Brouwer MH.

Does heparin pre-treatment affect the haemostatic system during and after cardiopulmonary bypass?

Perfusion 2001; 16: 3-12 .

Nicholson, SC , Keeling DM , Sinclair ME , Evans RD. Heparin pre-treatment does not alter heparin requirements during cardiopulmonary bypass . Br J Anaesth 2001; 87: 844-847 .

Ray MJ , Perrin EJ , Hawson GA. Proposed model to monitor heparin therapy using the concentrated thrombin time which allows standardisation of re-agents and improved estimation of heparin concentrations . Blood Coagul Fibrinolysis 1996; 5: 515-521 .

Hunt BJ , Parratt RN , Segal HC , Sheikh S , Kallis P , Yacoub M. Activation of coagulation and fibrinolysis during cardiothoracic operations . Ann Thorac Surg 1998; 65: 712-718 .

10.

Gelb AB , Roth RI , Levin J et al. Changes in blood coagulation during and following cardiopulmonary bypass: lack of correlation with clinical bleeding . Am J Clin Path 1996; 106: 87-99 .

11.

Perrin EJ , Ray MJ , Hawson GA. The role of von Willebrand factor in haemostasis and blood loss during and after cardiopulmonary bypass surgery . Blood Coagul Fibrinolysis 1995; 6: 650-658 .

12.

Hunt BJ. Desmopressin and bleeding during invasive surgery . Eur J Anaesth 1997; 14: 42-49 .

13.

Holdright DR , Hunt BJ , Parratt R et al. The effect of cardiopulmonary bypass on systemic and coronary levels of von Willebrand factor . Eur J Cardiothorac Surg 1995; 9: 18-21 .

14.

Kuitunen A , Hynynen M , Salmenpera M et al. Anaesthesia affects plasma concentrations of vasopressin, von Willebrand factor and coagulation factor VIII in cardiac surgical patients . Br J Anaesth 1993; 70: 173-180 .

15.

Pradhan MJ , Fleming JS , Nkere UU , Arnold J , Wild-evuur CH , Taylor KM. Clinical experience with heparin-coated CPB circuits . Perfusion 1991; 6: 235-242 .

16.

DeHaan J , Boonstra PW , Tabuchi N , van Oeveren W , Ebels T. Retransfusion of thoracic wound blood during heart surgery obscures biocompatibility of the extra-corporeal circuit . J Thorac Cardiovasc Surg 1996; 111: 272-275 .