title: Are all heparins safe for on-pump heart surgery?
abstract: BACKGROUND
  Intravenous Panpharma heparin(®) was used in all on-pump cardiac surgery in our heart-surgery department for a short period. This brand of heparin replaced the previous Choay heparin(®) heparin supplied by the Sanofi-Aventis Laboratory. Unusual postoperative bleedings over this period prompted us to evaluate postoperative hemostasis by comparing these two heparins.
  
  
  METHODS
  We compared data from patients who had undergone on-pump cardiac surgery during Panpharma heparin(®) period (group P, 257 patients) to those how received Choay heparin(®) (group C, 194 patients).
  
  
  RESULTS
  Despite group P receiving a significantly lower dose of heparin (mean dose 21,000 IU/CEC) compared to group C (mean dose 22,000 IU/CEC) (p = 0.05), the number of surgical re-explorations needed to perfect postoperative hemostasis was significantly higher for group P (3.5% vs. 0) (p = 0.01). Heparin anti-Xa activity after surgery was higher in group P at postoperative h1 and h12 compared to group C, which explained reoperations for hemostasis.
  
  
  CONCLUSIONS
  Despite standardization, variations remain regarding anticoagulant activity between different manufacturing processes and heparin preparations. Surgical teams need to be aware that the biological effects of different brands of heparin may not be as expected and could endanger a usually safe procedure, such as cardiac surgery.
authors.affiliation: a Heart Surgery Department , Clermont-Ferrand University Hospital , Clermont-Ferrand , France.|b INRA , UMR 1019 Nutrition Humaine , Saint Genès Champanelle , France.
authors.forename: Kasra
authors.initials: K
authors.lastname: Azarnoush
authors.affiliation: c Biostatistics Unit, Délégation Recherche Clinique & Innovation , Clermont-Ferrand University Hospital , Clermont-Ferrand , France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: b INRA , UMR 1019 Nutrition Humaine , Saint Genès Champanelle , France.|d Haematology Department , CHU Clermont-Ferrand , Clermont-Ferrand , France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Lebreton
authors.affiliation: e Centre de pharmacovigilance et laboratoire de pharmacologie, hôpital Gabriel-Montpied , centre hospitalier universitaire de Clermont-Ferrand , Clermont-Ferrand , France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Zenut
authors.affiliation: e Centre de pharmacovigilance et laboratoire de pharmacologie, hôpital Gabriel-Montpied , centre hospitalier universitaire de Clermont-Ferrand , Clermont-Ferrand , France.
authors.forename: Chouki
authors.initials: C
authors.lastname: Chenaf
authors.affiliation: a Heart Surgery Department , Clermont-Ferrand University Hospital , Clermont-Ferrand , France.
authors.forename: Eljezi
authors.initials: E
authors.lastname: Vedat
authors.affiliation: a Heart Surgery Department , Clermont-Ferrand University Hospital , Clermont-Ferrand , France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cosserant
authors.affiliation: f Service de biochimie médicale, Centre de biologie , CHU de Clermont-Ferrand , Clermont-Ferrand , France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bouvier
authors.affiliation: a Heart Surgery Department , Clermont-Ferrand University Hospital , Clermont-Ferrand , France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: d'Ostrevy
authors.affiliation: a Heart Surgery Department , Clermont-Ferrand University Hospital , Clermont-Ferrand , France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Camilleri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006487:Hemostasis; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Heparin; kaolin-cephalin coagulation time; surgical hemostasis; treatment outcome