[The significance of heparin concentration measurement during cardiopulmonary bypass--effect of heparin-coated circuit during normothermic bypass].
Recently, use of heparin-coated circuits during normothermic cardiopulmonary bypass has become a trend in cardiovascular surgery. In light of this, heparin administration protocols during bypass should be reevaluated. In twenty patients who underwent cardiac surgery using a heparin-coated circuit under normothermia, heparin concentration was measured with Hepcon/HMS. Before initiating bypass, 300 IU/kg of heparin was administered with additional heparin to maintain activated clotting time (ACT) at more than 400 seconds. The heparin dose response (HDR) was measured before heparin administration. HDR is a heparin concentration calculated to correspond to an ACT of 480 seconds. As an index of heparin control during bypass, average heparin concentration/HDR (HC/HDR) was calculated. HC/HDR was correlated with Fibrinogen degradation products E (R = -0.52). D dimer (R = -0.45). Thrombin antithrombin complex (R = -0.54). Antithrombin III (R = 0.50) and platelet number (R = 0.44), but not with 24-hour postoperative blood loss. In conclusion, even when using a heparin-coated circuit plasma coagulation activity was not sufficiently suppressed by use of a conventional ACT monitoring protocol during normothermic bypass. Therefore, the maintenance of HC/HDR at a higher level may be indicated.
Komiya
T
T
Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
Ban
K
K
Yamazaki
K
K
Ishii
O
O
Nakamura
T
T
Kanzaki
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D002648:Child; D004305:Dose-Response Relationship, Drug; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006331:Heart Diseases / Q000097:blood / Q000601:surgery; D006493:Heparin / Q000008:administration & dosage / Q000097:blood*; D006801:Humans; D008875:Middle Aged
D005338:Fibrin Fibrinogen Degradation Products; D000990:Antithrombin III; D005340:Fibrinogen; D006493:Heparin