Heart transplantation under coumarin therapy: friend or foe?
Thirty-six patients were included in a retrospective study of the effect of pre-operative anticoagulant therapy on peri-operative blood loss and haemostatic changes after heart transplantation. Eleven patients (group H) had received intravenous heparin for at least 3 weeks before cardiac transplantation. Twelve patients (group P) had been transplanted when fully anticoagulated with phenprocoumon. A control group of 13 patients (group C) had undergone bypass grafting of their coronary arteries with no pre-operative anticoagulant therapy. Post-operative drainage from the chest drains was 700 ml (median) in group H, 425 ml in group P, and 360 ml in group C (group H vs. group C: P < 0.05). After heparinization for cardiopulmonary bypass, activated clotting time was 462 s (median) in group H, 1500 s in group P, and 727 s in group C (P < 0.003 vs. groups H and P). Post-operatively, patients in group P were given more units of fresh frozen plasma (median 2.5 units; P < 0.01), prothrombin complex concentrate (median 1000 I.U.; P < 0.05) and vitamin K (median 10 mg; P < 0.05) than groups H and C. Heart transplantation under full phenprocoumon therapy does not increase the likelihood of complications caused by peri-operative bleeding.
Department of Cardiovascular Surgery, University of Kiel, Germany.
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M
Karck
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A
Haverich
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D015505:Chest Tubes; D001026:Coronary Artery Bypass; D005260:Female; D016027:Heart Transplantation; D006488:Hemostasis, Surgical; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010644:Phenprocoumon / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011516:Prothrombin / Q000627:therapeutic use; D012189:Retrospective Studies; D014812:Vitamin K / Q000627:therapeutic use; D014914:Whole Blood Coagulation Time
D014812:Vitamin K; D011516:Prothrombin; D006493:Heparin; D010644:Phenprocoumon