Heparin coating reduces blood cell adhesion to arterial filters during coronary bypass: A clinical study

Borowiec, Jan; Bylock, Anders; Linden, Jan van der; Thelin, Stefan

doi:10.1016/0003-4975(93)91106-w

Cited by 48 publications

(26 citation statements)

References 15 publications

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“…Borowiec et al demonstrated how adhesion to arterial filters during CPB diminishes as a result of heparin coating. 14 It is noteworthy that none of the oxygenators with heparin coating was registered for HPD.…”

Section: Discussionmentioning

confidence: 98%

The relative safety of an oxygenator

et al. 1997

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Analysis of prospectively registered incidents related to cardiopulmonary bypass (CPB) was initiated to establish the incident rate for 10 different oxygenator brands employed over a seven-year period in 5000 clinical perfusions. A general safety index (SI) was defined as the number of recorded incidents in a given series of oxygenators divided by its total number and multiplied by 100. Specific SI was calculated for each of the following categories: high-pressure drop, debris, gas exchange, leakage, material failure and oxygenator change-out. An SI of 0.2 was arbitrarily set as a reference and an acceptable safety level. An estimate of the relative risk for a particular oxygenator brand was compared with the reference by calculating the odd's ratio with a 95% confidence interval. The mean SI was determined to be 1.6, ranging from 0 for the Maxima CBAS and the Cobe CML to 2.92 for the Safe oxygenator. The dominating specific type of incident was HPD with an SI of 0.81 followed by debris, SI = 0.71. A systematic analysis of adverse events in CPB may be used to evaluate and to set standards, a method already employed in the pharmaceutical industry. Our results indicate that oxygenator safety margins may vary between different brands.

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Section: Discussionmentioning

confidence: 98%

The relative safety of an oxygenator

et al. 1997

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“…One approach to minimize such deleterious effects, which can lead to permanent dysfunction of many organs (2), is to improve the biocompatibility of ECC circuits. Surfaces recovered with heparin have been shown to improve thromboresistance, to inhibit the alternative pathway of complement activation, and to improve biocompatibility both in vitro and in vivo (3). It also permits the use of lower doses of systemic heparin, which can cause hemorrhagic complications (4).…”

mentioning

confidence: 99%

Importance of Uniform Heparin Coating on Biopolymers

2000

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Cardiopulmonary surgeries need connectors for extracorporeal circulation. The patient's blood in contact with the tube surfaces modifies its plasmatic proteins, promotes platelet aggregation, and activates the complement system, unleashing thrombus formation. Thus, it becomes necessary for an anticoagulant to keep the circuit free from these events. Heparin is the anticoagulant used even after reports about its disadvantages. Platelet adherence seems to be very dependent on the quality from the surfaces that can promote cellular proliferation, aggregation, and thrombosis. In this study, we compare the quality of the heparin-coated and uncoated surfaces. We used a blood cell culture and scanning electron microscopy (SEM) to visualize the platelet aggregation. It was concluded that there are groove areas that permit platelet adherence, and if they are not coated totally by the heparin, aggregation still occurs although in lower scale than on the uncoated tubes.

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“…Based on current experimental and clinical data, we believe that HBCs with lower levels of anticoagulation are more thromboresistant than conventional (nonheparin bonded) circuit with full anticoagulation. [17][18][19][20] As with all modifications, the techniques of CPB have to be adjusted to ensure patient safety and the limitations of these techniques have to be clearly understood.13 These limitations are not unique to HBCs, but are shared by all extracorporeal circulation modalities, although concerns are accentuated in the presence of lower anticoagulation. These concerns include identification with patients with hypercoagulable states or antithrombin Ill deficiencies, intraoperative administration of any drugs which shift the hemostatic balance and promote thrombosis, and avoidance of blood turbulence and stagnation.…”

Section: Resultsmentioning

confidence: 99%

Effective Use of Heparin-Bonded Circuits and Lower Anticoagulation for Coronary Artery Bypass Grafting in Jehovah's Witnesses

et al. 1996

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Despite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascularization still require homologous transfusions. Based on a large clinical experience with high-risk patients during coronary artery bypass, a comprehensive strategy to diminish perioperative blood loss was developed by integrating many individual components. An integral component in this strategy is the use of lower heparinization (activated clotting time [ACT] > 280 sec) in conjunction with "tip-to-tip" heparin-bonded cardiopulmonary bypass (CPB) circuits (HBC). This technique was prospectively applied to a group of Jehovah's Witnesses (JW) patients who refuse blood transfusion on religious grounds (n = 9). Outcome was compared to a matched group of patients treated with full heparinization (ACT > 480 sec) used with conventional, nonheparin-bonded CPB circuits (NHBC) performed within the same academic year (n = 455). There were no complications in JW patients who had a significantly lower mediastinal and pleural tube output in the first 24 hours (323 67 mL vs 984 616 mL, p < 0.01). In comparison to JW patients who received no transfusions, 68.1% of patients treated with NHBC were transfused (p 0.0001). In summary, HBC in conjunction with lower anticoagulation was effectively and safely applied to JW patients undergoing coronary artery bypass grafting. This technique should be considered for broader clinical use.

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Heparin coating reduces blood cell adhesion to arterial filters during coronary bypass: A clinical study

Cited by 48 publications

References 15 publications

The relative safety of an oxygenator

The relative safety of an oxygenator

Importance of Uniform Heparin Coating on Biopolymers

Effective Use of Heparin-Bonded Circuits and Lower Anticoagulation for Coronary Artery Bypass Grafting in Jehovah's Witnesses

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