title: Effect of low molecular weight heparin (fragmin) on bleeding after cardiac surgery.
abstract: BACKGROUND
  Fragmin (Dalteparin, Pharmacia Ltd, Milton Keynes, UK), a low molecular weight heparin, is now recommended in the treatment of unstable angina. Due to the greater bioavailability and longer half-life of Fragmin compared with conventional heparin we postulated that this may influence postoperative bleeding after cardiac surgery for unstable angina.
  
  
  METHODS
  We investigated the influence of the agent on postoperative bleeding after cardiac surgery. Patients undergoing first-time coronary artery bypass grafting were prospectively studied in four groups: group A (n = 100) were elective patients; group B (n = 60) had unstable angina and received conventional heparin intravenously until operation; group C (n = 115) received Fragmin with the last dose administered more than 12 hours before surgery; and group D (n = 115) received Fragmin within 12 hours of operation.
  
  
  RESULTS
  Patients in group D had significantly greater blood loss (p < 0.001) and increased blood transfusion than groups A, B, and C (p = 0.047). Patients receiving Fragmin more than 12 hours before surgery (group C) had similar rates of blood loss and transfusion to group B (p > 0.05) but greater than in group A (p = 0.021). There were no differences in reopening rate.
  
  
  CONCLUSIONS
  The risks of bleeding and transfusion must be weighed against the risks of acute ischemic events if Fragmin is stopped more than 12 hours before operation.
authors.affiliation: Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, England. s.c.clark@ncl.ac.uk
authors.forename: S C
authors.initials: SC
authors.lastname: Clark
authors.forename: N
authors.initials: N
authors.lastname: Vitale
authors.forename: J
authors.initials: J
authors.lastname: Zacharias
authors.forename: J
authors.initials: J
authors.lastname: Forty
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use*; D017985:Dalteparin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants; D017985:Dalteparin