Will high-dose heparin affect blood loss and inflammatory response in patients undergoing cardiopulmonary bypass?

Abstract

Introduction: We performed a randomized study to investigate if a high versus a standard dose of heparin dose during cardiopulmonary bypass could affect intra- and post-operative bleeding and reduce the inflammatory response. Methods: A total of 30 patients undergoing elective coronary artery bypass grafting were randomized into high or standard dose of heparin during cardiopulmonary bypass. Blood loss was documented peri- and post-operatively, and interleukin-6, tumor necrosis factor-α, and C3 were measured in conjunction with cardiopulmonary bypass. Results: Data from 29 patients were analyzed after exclusion of one patient. The mean initial bolus and total heparin doses were 43,000 ± 5,800 IU versus 35,000 ± 4,100 IU, (p < 0.001), and 58,000 ± 9,500 IU versus 45,000 ± 7,900 IU, (p < 0.001) in the intervention and the control group, respectively. The median intra-operative bleeding was 150 mL (interquartile range 100-325) in the control versus 225 mL (IQR 200-350) in the intervention group, p = 0.15. The median chest tube blood loss 12 hour post-operatively was 300 mL (interquartile range 250-385) in the control versus 450 mL (IQR 315-505) in the intervention group, p = 0.029. There was no significant difference between the control group and the intervention group during cardiopulmonary bypass for the measured inflammatory markers interleukin-6 (p = 0.98), tumor necrosis factor-α (p = 0.72), or C3 (p = 0.13). Conclusion: This small study showed a small increase of post-operative bleeding associated with higher heparin dosage in conjunction with cardiopulmonary bypass but did not demonstrate an effect of heparin on the inflammatory response to cardiopulmonary bypass.

A Blinded Randomized Trial Comparing Standard Activated Clotting Time Heparin Management to High Target Active Clotting Time and Individualized Hepcon HMS Heparin Management in Cardiopulmonary Bypass Cardiac Surgical Patients

“…Another recent prospective randomized trial by Braatz et al 27) compared high-dose heparin with goal ACT greater than 680 seconds to standard dose heparin with goal ACT greater than 480 seconds for CPB in 29 primary CABG patients. The high-dose heparin group received greater amounts of heparin and protamine than the standard dose heparin group.…”

Paraprotein associated heparin resistance during cardiopulmonary bypass

“…Excessively high doses of heparin during CPB increases the risk of perioperative bleeding and requirements for blood transfusion. 4 Bleeding is a common complication seen in platelet dyscrasias where there is an excess of monoclonal paraproteins. Paraproteins exhibit non-specific binding to multiple factors along the coagulation cascade and thus produce a variable and unpredictable effect on coagulation.…”

“…Excessively high doses of heparin during CPB increases the risk of perioperative bleeding and requirements for blood transfusion. 4…”