Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications.
OBJECTIVE
To evaluate the clinical impact of reduced heparin responsiveness (HR(reduced)) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB), and to identify the predictors of HR(reduced).


METHODS
A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis, 150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥ 300 s, and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HR(reduced)). The relationships between the HSI and postoperative MI, cardiac enzyme levels and preoperative risk factors of HR(reduced) were investigated.


RESULTS
There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HR(reduced) patients. HR(reduced) occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.


CONCLUSIONS
HR(reduced) was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients, which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HR(reduced).
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Sungnam, Korea.
Duk-hee
DH
Chun
Seong-wan
SW
Baik
So Yeon
SY
Kim
Jae Kwang
JK
Shim
Jong Chan
JC
Kim
Young Lan
YL
Kwak
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin