title: Fragmin (LMWH) vs heparin for anticoagulation during in vitro recycling of human blood in cardiopulmonary bypass circuits: dose-dependence and mechanisms of clotting.
abstract: Low-molecular-weight heparin (LMWH) (Fragmin) vs heparin was studied in vitro in order to investigate its antithrombotic efficacy in the isolated thrombogenic link of cardiopulmonary bypass (CPB). Fresh human blood (400 ml) with various dosages of the anticoagulant was recycled in a CPB circuit for 120 min. The standard dosage of heparin (1,500 IU, n = 6) was compared with a lower dosage (1,000 IU, n = 3) and several dosages of Fragmin (IU anti-FXa): 750 (n = 1), 1,500 (n = 3), 2,100 (n = 4) and 2,500 (n = 3). Clotting occurred in three Fragmin experiments at dosages of 750, 1,500 and 2,100 IU. This was associated with short activated clotting time (ACT) and activated partial thromboplastin time (aPTT) but was independent of the levels of anti-FXa, FVIII, von Willebrand factor and prothrombin complex. It was concluded that at least twice the dose of Fragmin (anti-FXa), compared with heparin, was required, suggesting that thrombin inhibition is crucial for the antithrombotic efficacy of heparin in CPB circuits. Absence of fibrinolytic markers suggests that the well known enhancement of fibrinolysis often seen during CPB, is not due to heparin interaction with normally circulating blood components, but rather to interaction with the vessel walls or to the surgical trauma itself.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Bagge
authors.forename: E
authors.initials: E
authors.lastname: Holmer
authors.forename: T
authors.initials: T
authors.lastname: Wahlberg
authors.forename: S O
authors.initials: SO
authors.lastname: Nyström
authors.forename: H
authors.initials: H
authors.lastname: Tydén
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D001782:Blood Donors; D002315:Cardiopulmonary Bypass; D017985:Dalteparin / Q000494:pharmacology*; D005260:Female; D006487:Hemostasis; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D006493:Heparin; D017985:Dalteparin