The antithrombin III-saving effect of reduced systemic heparinization and heparin-coated circuits.
OBJECTIVE
To investigate the perioperative changes of antithrombin III (AT-III) activity using reduced systemic heparinization and the possible role of AT-III in determining a better postoperative outcome.


METHODS
Prospective randomized study.


METHODS
University hospital.


METHODS
Patients undergoing elective coronary revascularization with cardiopulmonary bypass (n = 90).


METHODS
Of patients, 30 were treated with heparin-coated circuits and reduced systemic heparinization; 30, with heparin-coated circuits and full systemic heparinization; 30, with conventional circuits and full systemic heparinization.


RESULTS
Heparin-coated circuits with full systemic heparinization did not exert any effect on coagulation parameters. Low systemic heparinization resulted in a significantly (p < 0.01) higher hematocrit value on arrival in the intensive care unit and in significantly higher values of AT-III activity during cardiopulmonary bypass (66 +/- 12% v 57.4 +/- 13% and 59.1 +/- 12% in the full systemic heparinization groups; p < 0.05), on arrival in the intensive care unit (69.7 +/- 13% v 60.7 +/- 13% and 60.8 +/- 11% in the full systemic heparinization groups; p < 0.01), and on the first postoperative day (81.3 +/- 15% v 67.4 +/- 13% and 70.2 +/- 12% in the full systemic heparinization groups; p < 0.01). No differences were observed in the clinical outcome.


CONCLUSIONS
Reducing systemic heparinization determines an AT-III-saving effect that could be responsible for the decrease in thromboembolic complications already observed by other authors. It induces higher hematocrit levels immediately after the operation, probably reducing the unmeasurable intraoperative blood loss.
Ranucci
Marco
M
Departments of Cardiothoracic Anesthesia and Cardiac Surgery, Cardiovascular Center E. Malan-University of Milan, Istituto Policlinico S.Donato, Milan, Italy. m.ranucci@galactica.it
Cazzaniga
Anna
A
Soro
Giorgio
G
Isgrò
Giuseppe
G
Frigiola
Alessandro
A
Menicanti
Lorenzo
L
D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III / Q000032:analysis*; D001777:Blood Coagulation / Q000187:drug effects; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006400:Hematocrit; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013923:Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D000990:Antithrombin III; D006493:Heparin