Coagulofibrinolysis during heparin-coated cardiopulmonary bypass with reduced heparinization.
BACKGROUND
We examined the safety of reduced systemic heparinization during heparin-coated cardiopulmonary bypass by measuring coagulofibrinolitic indices, including fibrinopeptide A, which directly reflects fibrinogenesis.


METHODS
Twenty-four patients who had elective cardiac operations were perfused using a circuit coated with covalently bonded heparin. Twelve patients received 300 U/kg of heparin and the remaining 12 patients received 150 U/kg. Blood was obtained for the measurement of thrombin-antithrombin III complexes, fibrinopeptide A, plasmin-alpha 2 plasmin inhibitor complexes, and D-dimer preoperatively; after heparin administration; 10, 60, and 90 minutes after the start of bypass; after protamine administration; and 1, 3, 6, 12, and 24 hours after the end of bypass.


RESULTS
Preoperative, intraoperative, and postoperative variables including postoperative bleeding were not significantly different between the two groups. Further, there were no complications in either group. No significant differences between the two groups were noted for any hematologic index at any time point.


CONCLUSIONS
Reduced systemic heparinization combined with a heparin-coated cardiopulmonary bypass circuit is biochemically and clinically safe but does not reduce postoperative bleeding.
Kumano
H
H
Second Department of Surgery, Osaka City University Medical School, Japan.
Suehiro
S
S
Hattori
K
K
Shibata
T
T
Sasaki
Y
Y
Hosono
M
M
Kinoshita
H
H
D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000378:metabolism; D000990:Antithrombin III / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects* / Q000502:physiology; D005344:Fibrinopeptide A / Q000378:metabolism; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000378:metabolism; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced; D000979:alpha-2-Antiplasmin
D000933:Antifibrinolytic Agents; D020099:Coated Materials, Biocompatible; D005338:Fibrin Fibrinogen Degradation Products; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C037742:plasmin-plasmin inhibitor complex; D005344:Fibrinopeptide A; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases; D005341:Fibrinolysin