A reevaluation of heparin requirements for cardiopulmonary bypass

Cardoso, Paulo Francisco Guerreiro; Yamazaki, Fumio; Keshavjee, Shaf; Schäefers, Hans-Joachim; Hsieh, Chia-Ming; Wang, L.S.; Glynn, Michael; Patterson, G.A.; Cooper, Joel D.

doi:10.1016/s0022-5223(19)36806-0

Cited by 29 publications

(3 citation statements)

References 35 publications

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“…The dosage with conventional, uncoated extracorporeal circuits was originally established by empirically choosing the minimum drug quantity at which no clotting in the ECC system was observed (10). In subsequent animal experiments, Cardoso et al (11) showed that compared to control, ACT >450 s reduced ACT >250 <300 s, did not lead to significantly increased coagulation parameters, reduced oxygenator function, or signs of thrombosis during 3 h of ECC. Nevertheless most suppliers of ECC equipment recommend and consequently users employ an ACT in excess of 450 s.…”

Section: Discussionmentioning

confidence: 99%

Heparin‐Coated Extracorporeal Circulation with Full and Low Dose Heparinization: Comparison of Thrombin Related Coagulatory Effects

Mirow¹,

Brinkmann

Minami³

et al. 2001

Artificial Organs

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Thrombin related coagulatory effects of a heparin-coated cardiopulmonary bypass system combined with full and low dose systemic heparinization were investigated in a prospective, randomized study in coronary bypass surgery patients. One hundred nineteen patients were divided into 3 groups. Group A (n = 39) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IU/kg body weight. During ECC activated clotting time (ACT) was maintained at > or =480 s. Group B (n = 42) had the same ECC set completely coated with low molecular weight heparin. Intravenous heparin was given in the same dose as in Group A, and ACT was kept at the same level. Group C (n = 38) had the same coated ECC set as Group B, but intravenous heparin was reduced to 150 IU/kg, and during ECC, ACT was set to be > or =240 s. The same ECC components were used in all 3 groups including roller pumps, coronary suction, and an open cardiotomy reservoir. Thrombin generation as indicated by F1/F2 was significantly elevated at an ECC duration >60 min if heparin-coated ECC combined with low dose systemic heparinization was employed. Complexed thrombin (TAT) was significantly elevated after administration of protamine. Release of D-dimers indicating fibrinolysis was not significantly different between groups. Signs of clinical thromboembolism, i.e., postoperative neurological deficit, occurred in 2 patients in Group A and 1 patient in Group C. We conclude that heparin-coated extracorporeal circulation combined with reduced systemic heparinization intraoperatively leads to significantly increased thrombin generation, but not to increased fibrinolysis.

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Section: Discussionmentioning

confidence: 99%

Heparin‐Coated Extracorporeal Circulation with Full and Low Dose Heparinization: Comparison of Thrombin Related Coagulatory Effects

Mirow¹,

Brinkmann

Minami³

et al. 2001

Artificial Organs

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“…One potential method of reducing its effect is to reduce the dose used. What constitutes an acceptable dose of heparin for cardiopulmonary bypass may partly depend on the type of oxygenator used; a lower dose may be appropriate for a membrane oxygenator 53 . The use of heparin‐coated circuits has been advocated in cardiac surgery, principally to improve biocompatability.…”

Section: The Importance Of Blood Loss In Cardiac Surgerymentioning

confidence: 99%

“…What constitutes an acceptable dose of heparin for cardiopulmonary bypass may partly depend on the type of oxygenator used; a lower dose may be appropriate for a membrane oxygenator. 53 The use of heparin-coated circuits has been advocated in cardiac surgery, principally to improve biocompatability. But a lower-than-standard dose of heparin is possible in this situation and has been associated with reduced blood Ioss.…”

Section: Reduction In Heparin Usementioning

confidence: 99%

Current Methods to Reduce the Adverse Haematological Consequences of Cardiopulmonary Bypass

John

Deverall

1996

Int J Clinical Practice

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SUMMARY Bleeding remains a significant cause of morbidity after cardiac surgery and results in a major demand on blood transfusion capacity. The aetiology is multifactorial, but platelet dysfunction is the most important cause. Because of the potential risks of heterologous blood transfusion, a number of techniques have been developed to reduce its need. These can broadly be divided into three categories. First, modification of bypass methods and the use of agents such as aprotinin can reduce blood loss. Second, more use can be made of the patient's own blood through predonation of autologous blood or blood conservation techniques. Finally, transfusion policy can be modified so that a lower postoperative haemoglobin level is accepted. However, a method with which to preoperatively predict those patients who will bleed significantly remains elusive.

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Routine Use of Heparin-Bonded Circuits with Minimal Anticoagulation for Coronary Artery Bypass Surgery

Aldea¹,

Treanor²,

Shemin³

1998

Blood Conservation in Cardiac Surgery

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A reevaluation of heparin requirements for cardiopulmonary bypass

Cited by 29 publications

References 35 publications

Heparin‐Coated Extracorporeal Circulation with Full and Low Dose Heparinization: Comparison of Thrombin Related Coagulatory Effects

Heparin‐Coated Extracorporeal Circulation with Full and Low Dose Heparinization: Comparison of Thrombin Related Coagulatory Effects

Current Methods to Reduce the Adverse Haematological Consequences of Cardiopulmonary Bypass

Routine Use of Heparin-Bonded Circuits with Minimal Anticoagulation for Coronary Artery Bypass Surgery

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