title: Low dose systemic heparinization combined with heparin-coated extracorporeal circulation. Effects related to platelets.
abstract: BACKGROUND
  A heparin coated cardiopulmonary bypass system combined with full and low dose systemic heparinization in coronary bypass surgery was investigated in a prospective, randomised study. Roller pumps, coronary suction and an open cardiotomy reservoir were used.
  
  
  METHODS
  One hundred and nineteen patients were divided into 3 groups: group A (n=39) had a standard uncoated extracorporeal circulation (ECC)-set and systemic heparin was given in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept at = or >480 sec. Group B (n=42) had the same ECC-set completely coated with low molecular weight heparin, i.v. heparin was administered in the same dose as in group A, ACT was again kept at = or >480 sec. Group C (n=38) had the same coated ECC set as group B, but i.v. heparin was reduced to 150 IE/kg and during ECC ACT was maintained of = or >240 sec.
  
  
  RESULTS
  Platelet decrease was significantly less in both groups utilizing coated circuitry as compared to control group A. Activation of thrombocytes as marked by b-thromboglobulin (not PF4) was significantly decreased in patients treated with coated circuits combined with low dose systemic heparinization and postoperative bleeding was significantly reduced.
  
  
  CONCLUSIONS
  We conclude that in heparin coated extracorporeal circulation combined with either full dose or reduced systemic heparinization compared to uncoated circuits platelet count reduction is significantly less. Platelet activation as marked by b-thromboglobulin and postoperative blood loss are decreased with coated equipment and low i.v. heparinization.
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany. nmirow@hdz-nrw.ruhu-uni-bochum.de
authors.forename: N
authors.initials: N
authors.lastname: Mirow
authors.forename: T
authors.initials: T
authors.lastname: Brinkmann
authors.forename: K
authors.initials: K
authors.lastname: Minami
authors.forename: G
authors.initials: G
authors.lastname: Tenderich
authors.forename: S
authors.initials: S
authors.lastname: Schulte-Eistrup
authors.forename: K
authors.initials: K
authors.lastname: Kleesiek
authors.forename: R
authors.initials: R
authors.lastname: Körfer
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects* / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects* / Q000502:physiology; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects / Q000502:physiology; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006493:Heparin