Heparin resistance during cardiopulmonary bypass

Esposito, Giovanni; Culliford, Alfred T.; Colvin, Stephen B.; Thomas, Stephen J.; Lackner, Henriette; Spencer, Frank C.

doi:10.1016/s0022-5223(19)37564-6

Cited by 88 publications

(27 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(15)(16)(17) During CPB some studies point that heparin dose and anticoagulation is not proportional but there is an exponential relation between them. (18,19) There is not a universal figure for an optimal ACT time for CBP, but 400-480 seconds of ACT stands as consensus. (20,21) A study shows us most clinics in USA and Canada targets 400-480 seconds of ACT during CPB .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Özkan¹,

Özkan²,

Oto³

2018

ejcm

View full text Add to dashboard Cite

Coagulation cascade starts with exsanguination or any contact of blood with an extracorporeal surface (1-5). Since invention of heparin molecule in 1916, it has been an essential application for cardiopulmonary bypass (CPB). Nowadays during CPB we have been using Activated Clotting Time (ACT) test because it results quicker than other laboratory tests to evaluate anticoagulation of heparin. (6-10) During CPB, high anticoagulation levels would result with unexpected high rate non-surgical bleeding. However, lower anticoagulation doses would end up with high rate of thromboembolic events. Both situations can be related with high mortality or morbidity. (13) There have been guidelines about blood conservation in cardiac surgery but clinical management of anticoagulation during CPB is not standardized. (14) In this respect, so far there has not been an ideal universal ACT value. Most clinics sets ACT target as above 400-480 seconds during CPB. (11,12) Over the years most clinics apply 300 IU/kg dose heparin regimen which has been empirically advanced and universally accepted for CPB to reach target ACT values, but this regimen sometimes can lead to higher ACT values. (13) This situation may cause to more postoperative bleeding, more postoperative blood transfusion and prolonged intensive care staying, although heparin is antagonized with protamine at the end of CPB. In this study we would like to compare retrospectively patients under went open heart surgery whom ACT's during CPB were 400-650 seconds with the patients whom ACT's were 650 seconds and higher during CPB.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Özkan¹,

Özkan²,

Oto³

2018

ejcm

View full text Add to dashboard Cite

show abstract

“…Only the use of any kind of heparin, regardless of the method of administration, was identified as a statistically significant independent risk factor for fatal myocardial infarction, with a relative risk of 2.06. Preoperative heparin therapy may be responsible for heparin resistance during cardiopulmonary bypass [15–17]: the majority of authors ascribe this effect to a chronic antithrombin‐III consumption [15,17,18], but other mechanisms have been claimed. Other possible mechanisms involved in heparin resistance after heparin therapy are an enhancement of factor VIII activity [19] and heparin‐induced thrombocytopenia [20].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for fatal myocardial infarction after coronary bypass graft surgery

Ranucci¹,

Frigiola

Menicanti

et al. 2001

Eur J Anaesthesiol

View full text Add to dashboard Cite

show abstract

“…Only the use of any kind of heparin, regardless of the method of administration, was identified as a statistically significant independent risk factor for fatal myocardial infarction, with a relative risk of 2.06. Preoperative heparin therapy may be responsible for heparin resistance during cardiopulmonary bypass [15][16][17]: the majority of authors ascribe this effect to a chronic antithrombin-III consumption [15,17,18], but other mechanisms have been claimed. Other possible mechanisms involved in heparin resistance after heparin therapy are an enhancement of factor VIII activity [19] and heparin-induced thrombocytopenia [20].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for fatal myocardial infarction after coronary bypass graft surgery

Ranucci¹,

Frigiola

Menicanti

et al. 2001

European Journal of Anaesthesiology

View full text Add to dashboard Cite

Background and objective The incidence and clinical impact of perioperative myocardial infarction during coronary artery bypass graft surgery vary greatly depending upon the diagnostic criteria applied. Fatal perioperative myocardial infarction has a less arguable diagnosis and clinical impact. The aim of this paper is to find out the risk factors for fatal myocardial infarction after coronary surgery. Methods Data from 1561 consecutive patients, who underwent coronary revascularization during a 10month period, have been retrospectively analysed. After an univariate analysis for pre-and intraoperative risk factors, a multivariate model (logistic regression analysis) was settled. Results Preoperative use of subcutaneous/intravenous heparin, a heparin sensitivity index <1.3 and need for a thromboendarterectomy of the left anterior descending coronary artery are independent risk factors for fatal myocardial infarction. The relative risk for fatal myocardial infarction was about 2 in the case of preoperative heparin use or heparin sensitivity index <1.3 and 5.5 in the case of thromboendarterectomy of the left anterior descending coronary artery. Conclusions In patients undergoing coronary artery bypass surgery, preoperative anticoagulation management with heparin may represent a risk factor for fatal myocardial infarction. Patterns of heparin resistance, whether or not due to heparin pretreatment, seem to be closely related to fatal myocardial infarction.

show abstract

Heparin resistance during cardiopulmonary bypass

Cited by 88 publications

References 22 publications

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Comparison of Short and Prolonged ACT Groups During Cardiopulmonary Bypass about Postoperative Drainage and Blood Transfusion

Risk factors for fatal myocardial infarction after coronary bypass graft surgery

Risk factors for fatal myocardial infarction after coronary bypass graft surgery

Contact Info

Product

Resources

About