Selective Use of Heparin in Aortic Surgery

Abstract

The incidence of distal ischaemia following aortic reconstruction may be as high as 25%, despite the use of systemic heparin. As anticoagulation may be associated with excessive operative blood loss, a retrospective study was performed to assess the prevalence of these problems, in a consecutive series, during a 30‐month period. Evaluation of reconstruction was possible in 161 patients with aneurysm and 38 patients with occlusive disease. The incidence of vessel occlusion was 21% in the occlusive and 4% in the aneurysm group (P < 0.05). Four of seven patients who had major vessel occlusion had serious complications. and there were two resultant deaths. These problems occurred despite the administration of heparin. Blood loss and operating time were quantitated in the patients who had resection for aortic aneurysm. Both were significantly longer in patients who received heparin (P < 0.05) and the differences were maintained when patients were stratified according to increments in dose or operating time, and according to whether woven tube or bifurcation grafts were performed. It was concluded that aneurysm surgery, in the absence of distal occlusive disease, could be safely performed without the use of systemic heparin, but surgery for occlusive disease still requires heparinization.

Prophylactic Perioperative Anti-Thrombotics in Open and Endovascular Abdominal Aortic Aneurysm (AAA) Surgery: A Systematic Review

“…10 Selection bias was suspected in all other studies, 22,24e26 and in three studies a selective loss to follow-up could not be excluded. 22,25,26 None of the studies presented details about exclusion criteria and excluded patients. A clear description of confounders could not be retrieved from any of the studies.…”

“…Data were collected prospectively in three studies 22,24,25 and retrospectively in one study. 26 One study concerned an RCT. 10 In all studies, heparin was administered intravenously before cross-clamping and results were compared to a blank control group.…”

“…10 In all studies intravenous administration of heparin before cross-clamping was used and results were compared to a blank control group. One study 26 included 38 patients with aortic-iliac occlusive disease (AIOD) and 161 with aneurismal disease. The authors excluded the patients with AIOD from evaluation, and we consequently excluded them from this review.…”

“…10,24,25 The incidence of ATEC could be retrieved from four studies. 10,24e26 Mortality details were reported as data within 30 days of the operation in three studies, 10,22,24 details for MI and ATEC within 30 days in two studies, 10,24 one study 26 provided the in-hospital data and from one study 26 no details could be retrieved about the time relation between surgery and postoperative mortality and morbidity. Main patient and study characteristics are shown in Table 1.…”

“…The protocol for heparin administration varied widely between the studies. In two studies, 24,26 administration of heparin depended on the surgeon's preference. In the RCT 10 the options were local surgeon's normal intra-operative heparin regimen or no heparin at all.…”