Heparin coating of the extracorporeal circuit combined with leukocyte filtration reduces coagulation activity, blood loss and blood product substitution.
BACKGROUND
Cardiopulmonary bypass is associated with activation of the coagulation cascade. Occasionally, this results in postoperative hemorrhage and consequently the need for blood products associated with increasing costs and risk of infection. Contact activation of the intrinsic coagulation pathway, and damage to cellular blood components with the release of proteolytic substances from neutrophil granulocytes have been linked to these coagulation disorders.


METHODS
Eighteen routine CABG-patients were randomly assigned to totally heparin coated circuits (Bioline coating) combined with leukocyte filtration in a double blind protocol (group I), 34 patients served as controls (group II). Leukocyte filters were activated before release of the aortic crossclamp. Coagulation activity, postoperative blood loss, and substitution with blood products were assessed.


RESULTS
Blood loss in the first 24h after surgery was significantly lower with combined application of heparin coating and leukocyte filters (group I) vs. controls (group II) (526+/-78 ml vs. 786+/-88 ml; p<0.05). Thrombin formation represented by prothrombin fragments 1+2 was significantly lower in group I vs. group II after declamping of the aorta (2.1+/-0. 3 nmol/L vs. 4.0+/-0.3 nmol/L; p<0. 05). Group I showed higher AT II plasma than group II (48.8+/-3.2% vs. 41.5+/-1.77%; p<0.05).


CONCLUSIONS
Leukocyte filtration during reperfusion in heparin coated cardiopulmonary bypass circuits is associated with lower coagulation activation, decreased blood loss and reduced transfusion of packed red cells in elective CABG patients.
Martens
S
S
Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt am Main, Germany.
Matheis
G
G
Wimmer-Greinecker
G
G
Feuerbach
J
J
Jakob
A
A
Mierdl
S
S
Moritz
A
A
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000379:methods; D004211:Disseminated Intravascular Coagulation / Q000517:prevention & control*; D004311:Double-Blind Method; D005112:Extracorporeal Circulation; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000139:chemically induced
D000925:Anticoagulants; D006493:Heparin