Heparin-coated cardiopulmonary bypass circuits: hemostatic alterations and postoperative blood loss.
This prospective, randomized study involving patients undergoing isolated coronary artery bypass grafting investigated whether the use of heparin-coated bypass circuits with an uncoated cardiotomy reservoir (n = 10) compared with standard uncoated bypass circuits (n = 10) resulted in differences in patient outcome and hemostatic alterations. There were no differences in postoperative blood loss, transfusion requirements, and routine coagulation test results between groups. Immunoassays for platelet alpha-granule constituents platelet factor 4 and beta-thromboglobulin, thrombin generation by-product F1.2, fibrinopeptide A, thrombin-antithrombin complex, and fibrinolysis by-product D-dimer also demonstrated no significant differences between groups, although trends for lower platelet secretion with heparin coating were noted. Increases were found in beta-thromboglobulin and platelet factor 4 concentrations at 10 (p < 0.03) and 30 minutes (p < 0.001) of CPB, respectively, and continuing throughout CPB (p < 0.001) for both groups versus values measured before incision. No significant differences were seen between levels 5 minutes prior to aortic cross-clamp release and those obtained 8 and 45 minutes after cross-clamp release. Conversely, no significant increases in F1.2, thrombin-antithrombin complex, and D-dimer were seen prior to release of the aortic cross-clamp, but afterward increases occurred that were highly significant (p < 0.001). The temporal data suggest that platelet activation occurs primarily as a result of contact with the cardiopulmonary bypass circuitry, whereas thrombin generation and fibrinolytic activity are not significant until reperfusion of the heart and lungs.(ABSTRACT TRUNCATED AT 250 WORDS)
Wagner
W R
WR
Department of Surgery, University of Pittsburgh, Pennsylvania.
Johnson
P C
PC
Thompson
K A
KA
Marrone
G C
GC
D000368:Aged; D000990:Antithrombin III / Q000032:analysis / Q000187:drug effects; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D003250:Constriction; D003327:Coronary Disease / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000187:drug effects / Q000601:surgery*; D005260:Female; D005344:Fibrinopeptide A / Q000032:analysis / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis / Q000187:drug effects; D010978:Platelet Factor 4 / Q000032:analysis / Q000187:drug effects; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D013499:Surface Properties; D001620:beta-Thromboglobulin / Q000032:analysis / Q000187:drug effects
C046193:antithrombin III-protease complex; D001620:beta-Thromboglobulin; D005344:Fibrinopeptide A; D010978:Platelet Factor 4; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases