Use of heparin-coated cardiopulmonary bypass circuit with low-dose heparin reduces postoperative bleeding.
Postoperative bleeding was examined in patients undergoing cardiopulmonary bypass with a heparin-coated circuit and low-dose heparin. Out of 150 patients who underwent cardiopulmonary bypass for longer than 90 minutes, 74 received a standard dose (300 IU/kg) of heparin with an uncoated circuit (group C) and 76 received a low-dose (150 IU/kg) of heparin with a heparin-coated circuit (group H). The coagulation and fibrinolytic systems were investigated in 24 patients. Re-opening of the chest due to bleeding was performed in 5 patients in group C (7%), but none of the patients in group H (p=0. 03). The median of blood loss in the first 12 hours after surgery was 292 ml in group C, and 216 ml in group H (p=0.006). There were no significant differences in the peak thrombin-antithrombin complex concentration between the two groups. The plasmin-alpha 2 plasmin inhibitor complex concentrations after protamine administration were 1.9 ng/ml (median) in group C and 1.1 ng/ml in group H (p=0.002). The use of heparin-coated cardiopulmonary bypass circuits with low-dose heparin suppressed the activation of fibrinolysis. This may explain the reduction in postoperative bleeding.
Suehiro
S
S
Division of Cardiovascular Surgery, Second Department of Surgery, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno, Osaka 545-8585, Japan.
Shibata
T
T
Sasaki
Y
Y
Hattori
K
K
Kumano
H
H
Hosono
M
M
Kinoshita
H
H
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000502:physiology; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin