Heparin-coated bypass circuits (Carmeda) suppress the release of tissue plasminogen activator during normothermic coronary artery bypass graft surgery.
OBJECTIVE
To study fibrinolysis in a homogeneous first-time coronary artery bypass surgery (CABG) population in whom heparin-coated circuits were used.


METHODS
A prospective, blinded, randomized, placebo-controlled study.


METHODS
A university hospital, tertiary care, intraoperative and postoperative intensive care unit.


METHODS
Twenty-one adult elective primary CABG patients.


METHODS
Randomized circuit-type centrifugal pump, membrane oxygenator, rigid cardiotomy reservoir, either placebo (n = 10) or heparin-coated (n = 11) (Carmeda; Medtronic Inc., Anaheim, CA).


RESULTS
Blood samples were analyzed for tissue plasminogen activator (TPA) activity, TPA antigen, plasminogen activator inhibitor-1 (PAI-1) activity, prothrombin complex F1.2, and antithrombin III (AT-III) at the following times: before cardiopulmonary bypass (CPB), during CPB (30 and 60 minutes), post-CPB, and day 1 postsurgery. TPA activity and antigen increased fivefold in the placebo group during CPB, whereas it did not even double in the heparin-coated group. PAI-1, F1.2, and AT-III were not different between groups.


CONCLUSIONS
Heparin-coated CPB circuits reduced TPA release in this homogeneous CABG population with routine heparin/protamine management.
Spiess
B D
BD
Department of Anesthesiology, University of Washington, Seattle 98195, USA.
Vocelka
C
C
Cochran
R P
RP
Soltow
L
L
Chandler
W L
WL
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D000990:Antithrombin III / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D001026:Coronary Artery Bypass; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage; D011516:Prothrombin / Q000378:metabolism; D013927:Thrombosis / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000097:blood*
D000925:Anticoagulants; D017395:Plasminogen Activator Inhibitor 1; D011479:Protamines; D000990:Antithrombin III; D011516:Prothrombin; D006493:Heparin; D010959:Tissue Plasminogen Activator