title: The antithrombin III-saving effect of reduced systemic heparinization and heparin-coated circuits.
abstract: 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.
authors.affiliation: Departments of Cardiothoracic Anesthesia and Cardiac Surgery, Cardiovascular Center E. Malan-University of Milan, Istituto Policlinico S.Donato, Milan, Italy. m.ranucci@galactica.it
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.forename: Anna
authors.initials: A
authors.lastname: Cazzaniga
authors.forename: Giorgio
authors.initials: G
authors.lastname: Soro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isgrò
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D000990:Antithrombin III; D006493:Heparin