title: An ex vivo evaluation of blood coagulation and thromboresistance of two extracorporeal circuit coatings with reduced and full heparin dose.
abstract: OBJECTIVE
  Bioactive Carmeda® heparin-coated extracorporeal circuits (ECCs) have been shown to reduce contact phase and coagulation activation during cardiopulmonary bypass (CPB). Heparin coating is therefore effective in safely reducing coagulation during routine CPB. Balance® Biosurface is a new, recently developed biopassive coating containing negatively charged sulphonated polymers. This study sought to compare the clotting activation and thromboresistance of the Balance® (B) circuit with that of the Carmeda® (C) with full-dose systemic heparin (FDH) and reduced-dose systemic heparin (RDH).
  
  
  METHODS
  This ex vivo study set-up comprising 40 experiments consisted of simplified ECC and circulation of freshly donated human blood. RDH and FDH regimens were obtained with 0.5 IU/ml and 1 IU/ml heparin administered to reach target activated clotting times (ACTs) of 250 and 500 s, respectively. The study design comprised four groups: FDH-C, FDH-B, RDH-C and RDH-B (all n = 10). Blood was sampled prior to and during the 2-h CPB. Coagulation activation was assessed (FXIIa, F1.2) and electron microscope scan imaging of oxygenators enabled determination of adhesion scores.
  
  
  RESULTS
  With a biopassive compared with bioactive surface, mean ACT was lower, regardless of the heparin regimen applied (P < 0.001), whereas the total heparin dose required to maintain ACT was above target level (P < 0.001). However, FXIIa and F1.2 values were similar in all groups throughout, as were pressure gradients among oxygenators. All groups demonstrated similar adhesion scores following ultrastructural oxygenator assessment.
  
  
  CONCLUSIONS
  In the absence of surgical-related haemostatic disturbances and based on target ACT levels under reduced- or full-dose heparin, the clotting process was similar to heparin-coated and new sulphonated polymer-coated ECC, both demonstrating similar thromboresistance.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cardiopulmonary Bypass Unit, University Hospital of Angers, Angers, France Department of Anesthesiology, VU University Medical Center, ICaR-VU, Amsterdam, Netherlands.
authors.forename: Leylah
authors.initials: L
authors.lastname: Teligui
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cardiopulmonary Bypass Unit, University Hospital of Angers, Angers, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Dalmayrac
authors.affiliation: SCIAM, University of Angers, Angers, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Mabilleau
authors.affiliation: Laboratory of Hematology, University Hospital of Angers, Angers, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Macchi
authors.affiliation: Laboratory of Hematology, University Hospital of Angers, Angers, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Godon
authors.affiliation: Department of Anesthesiology, University Hospital of Angers, Angers, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Corbeau
authors.affiliation: Laboratory of Immunology, University Hospital of Angers, Angers, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Denommé
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cardiopulmonary Bypass Unit, University Hospital of Angers, Angers, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bouquet
authors.affiliation: Department of Anesthesiology, VU University Medical Center, ICaR-VU, Amsterdam, Netherlands.
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cardiopulmonary Bypass Unit, University Hospital of Angers, Angers, France chbaufreton@chu-angers.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Baufreton
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D015956:Factor XIIa / Q000378:metabolism; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011516:Prothrombin; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control*; D013997:Time Factors; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D020099:Coated Materials, Biocompatible; D010446:Peptide Fragments; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D006493:Heparin; D015956:Factor XIIa
keywords: Cardiopulmonary bypass; Coagulation; Surface coating; Thromboresistance