Heparin versus danaparoid in off-pump coronary bypass grafting: results of a prospective randomized clinical trial.
OBJECTIVE
The incidence of heparin-induced thrombocytopenia is increasing, and the thrombin inhibitor danaparoid could be a useful alternative. The objective of the present study was to compare danaparoid and heparin in patients undergoing off-pump coronary artery bypass grafting.


METHODS
In a prospective, randomized, double-blind clinical trial comparing heparin (bolus of 1 mg/kg) with danaparoid (bolus of 40 U/kg), 71 patients underwent off-pump coronary artery bypass grafting with one of the study drugs. The amount of blood lost, the number of homologous blood products transfused, the troponin T levels, and the amount of anti-Xa activity were monitored.


RESULTS
Thirty-four patients underwent 2.6 +/- 0.7 bypasses with danaparoid, and 37 patients underwent 2.5 +/- 0.9 grafts with heparin (P =.8). Postoperative blood losses averaged 1394 +/- 1033 mL in patients receiving danaparoid and 1130 +/- 868 mL in patients receiving heparin (P =.2). The number of homologous blood products transfused averaged 3.6 +/- 7 units in patients receiving danaparoid and 1.9 +/- 4.4 units in patients receiving heparin (P =.2). The number of patients requiring homologous blood transfusion was higher in patients receiving danaparoid (18/34 [53%]) than in patients receiving heparin (10/37 [27%], P =.03). Serum anti-Xa activity averaged 1.6 +/- 0.6 U/mL in patients receiving danaparoid and 1.9 +/- 0.8 U/mL in patients receiving heparin 30 minutes after injection of the drugs (P =.1) and 0.3 +/- 0.1 and 0.04 +/- 0.08 U/mL, respectively, 12 hours after coronary artery bypass grafting (P =.001). Troponin serum levels were similar 48 hours after coronary artery bypass grafting (0.5 +/- 0.6 and 0.4 +/- 0.6 microg/L, respectively).


CONCLUSIONS
Although off-pump coronary artery bypass grafting with danaparoid versus heparin increases the number of patients exposed to homologous blood transfusion (relative risk, 2; 95% confidence limits, 1-4), off-pump coronary artery bypass grafting with danaparoid is a valuable alternative to heparin in patients with thrombocytopenia requiring surgical intervention.
Carrier
Michel
M
Department of Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada. carrier@icm.umontreal.ca
Robitaille
Danielle
D
Perrault
Louis P
LP
Pellerin
Michel
M
Pagé
Pierre
P
Cartier
Raymond
R
Bouchard
Denis
D
D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000145:classification / Q000601:surgery; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D016903:Drug Monitoring; D065427:Factor Xa Inhibitors; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000139:chemically induced; D020107:Troponin T / Q000097:blood
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D065427:Factor Xa Inhibitors; D006493:Heparin; D006497:Heparan Sulfate; D020107:Troponin T; C035838:danaparoid