title: Assessment of hemostatic activation during cardiopulmonary bypass for coronary artery bypass grafting with bivalirudin: results of a pilot study.
abstract: OBJECTIVE
  Bivalirudin has been successfully used as a replacement for heparin during on-pump coronary artery bypass grafting. This study was conducted to assess the effects of the currently suggested protocol for bivalirudin on hemostatic activation during cardiopulmonary bypass with and without cardiotomy suction.
  
  
  METHODS
  Ten patients scheduled for coronary artery bypass grafting were enrolled. Bivalirudin was given with a bolus of 50 mg in the priming solution and 1.0 mg/kg for the patient, followed by an infusion of 2.5 mg . kg(-1) . h(-1) until 15 minutes before the conclusion of cardiopulmonary bypass. Cardiopulmonary bypass was performed with a closed system in 5 patients with and in 5 patients without the use of cardiotomy suction. Blood samples were obtained before and after cardiopulmonary bypass. D-dimers, fibrinopeptide A, prothrombin 1 and 2 fragments, thrombin-antithrombin, and factor XIIa were determined.
  
  
  RESULTS
  Values for factor XIIa remained almost unchanged in both groups, indicating a minor effect of contact activation. In patients without cardiotomy suction, post-cardiopulmonary bypass values for D-dimers, fibrinopeptide A, prothrombin 1 and 2 fragments, and thrombin-antithrombin were not significantly increased compared with pre-cardiopulmonary bypass values. In patients with cardiotomy suction, values obtained for these parameters had significantly increased compared with pre-cardiopulmonary bypass values and the values obtained in the group without cardiotomy suction after cardiopulmonary bypass.
  
  
  CONCLUSIONS
  With this protocol, hemostatic activation during cardiopulmonary bypass was almost completely attenuated when cardiotomy suction was avoided. Cardiotomy suction results in considerable activation of the coagulation system and should therefore be restricted and replaced by cell saving whenever possible.
authors.affiliation: Department of Anesthesia, Deutsches Herzzentrum Berlin, Berlin, Germany. koster@dhzb.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: Ruhi
authors.initials: R
authors.lastname: Yeter
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.forename: Hermann
authors.initials: H
authors.lastname: Kuppe
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
authors.forename: Cornelius M
authors.initials: CM
authors.lastname: Dyke
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.forename: Bruce
authors.initials: B
authors.lastname: Spiess
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000494:pharmacology*; D010865:Pilot Projects; D011994:Recombinant Proteins / Q000494:pharmacology*; D013396:Suction
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin