Heparin-coated extracorporeal circulation in combination with low dose systemic heparinization reduces early postoperative blood loss in cardiac surgery.
OBJECTIVE
According to a recently performed meta-analysis, heparin-bonded circuits do not reduce blood loss in cardiac surgery patients compared to nonheparin-bonded circuits within the first 24 h postoperatively. We investigated the effects of heparin-coated circuits in combination with a reduced systemic heparin dose on early postoperative blood loss (first 12 h), platelet function, and postoperative complications.


METHODS
Patients who underwent their first coronary artery bypass graft surgery were included in a randomized prospective study. Group A (n=149) was perfused with an uncoated extracorporeal circulation (ECC)-set and groups B (n=152) and C (n=149) with heparin-coated ECC-sets. In groups A and B, conventional dose systemic heparin was given, whereas group C received low dose systemic heparin. Blood loss was assessed within the first 12 h postoperatively. Moreover, biochemical parameters of pro-coagulant activity and immunological function were measured.


RESULTS
None of the pro-coagulant activity markers and immunological parameters measured differed preoperatively or postoperatively between study groups. However, intraoperative platelet counts and maximal intraoperative concentrations of platelet factor 4, ss-thromboglobulin, and poly-morpho-nuclear (PMN)-elastase were lowest in group C, whereas group C also had the highest concentrations of thrombin-antithrombin complex (P<0.018-0.001). Blood loss within the first 12 h postoperatively was 457 +/- 204 mL in group A, 431 +/- 178 mL in group B, and 382 +/- 188 mL in group C (P<0.01). Complication rates and 30-day mortality did not differ between study groups.


CONCLUSIONS
The combined use of heparin-coated circuits and low dose systemic heparinization is able to reduce early postoperative blood loss without enhancing the risk of complications.
Mirow
N
N
Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany. nmirow@hdz-nrw.de
Zittermann
A
A
Koertke
H
H
Maleszka
A
A
Knobl
H
H
Coskun
T
T
Kleesiek
K
K
Koerfer
R
R
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III; D020099:Coated Materials, Biocompatible; D001026:Coronary Artery Bypass; D005112:Extracorporeal Circulation / Q000295:instrumentation; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood; D010978:Platelet Factor 4 / Q000097:blood; D019106:Postoperative Hemorrhage / Q000517:prevention & control*
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; C046193:antithrombin III-protease complex; D010978:Platelet Factor 4; D000990:Antithrombin III; D006493:Heparin; D010447:Peptide Hydrolases; D019272:Leukocyte Elastase