Heparin resistance after intraoperative platelet-rich plasma harvesting.
Records of anticoagulation for cardiopulmonary bypass from 58 patients who underwent elective coronary artery revascularization were analyzed to determine whether the harvesting of autologous platelet-rich plasma produces heparin resistance. The effect of preoperative heparin therapy on anticoagulation for cardiopulmonary bypass after harvesting of platelet-rich plasma was also evaluated. Patients were grouped by presence of preoperative heparin therapy and type of blood component harvested before cardiopulmonary bypass, including platelet-rich plasma, autologous whole blood, both, or neither. The dose of heparin required to initiate and to maintain anticoagulation for cardiopulmonary bypass was determined for each patient, and the groups were compared by two-way analysis of variance. Significantly more heparin was required to maintain anticoagulation for cardiopulmonary bypass in the platelet-rich plasma group than in the groups receiving autologous whole blood or no blood products. More heparin was also required to initiate and to maintain anticoagulation for cardiopulmonary bypass after preoperative heparin therapy. These results reinforce the concept that anticoagulation during cardiopulmonary bypass must be carefully monitored, and increased vigilance may be warranted in patients after harvesting of platelet-rich plasma.
Wickey
G S
GS
Department of Anesthesia, University Hospital, Pennsylvania State University College of Medicine, Hershey.
Keifer
J C
JC
Larach
D R
DR
Diaz
M R
MR
Williams
D R
DR
D000704:Analysis of Variance; D001777:Blood Coagulation / Q000187:drug effects; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005112:Extracorporeal Circulation; D006493:Heparin / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007430:Intraoperative Care; D010956:Plasmapheresis / Q000706:statistics & numerical data; D017713:Platelet Transfusion; D011300:Preoperative Care
D006493:Heparin