Document Detail


Heparin anticoagulation in patients undergoing off-pump and on-pump coronary bypass surgery.
MedLine Citation:
PMID:  17680178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The authors analyzed the coagulation data of patients who underwent on-pump coronary artery bypass graft (CABG) or off-pump coronary artery bypass surgery (OPCAB) in a randomized prospective trial. METHODS: CABG and OPCAB patients received heparin anticoagulation at 400 U x kg(-1), and 180 U x kg(-1) plus 3000 U every 30 min, respectively. In addition, OPCAB patients received a rectal aspirin, 650 mg, during the procedure. Perioperative coagulation test results (platelet count, fibrinogen, prothrombin time, partial thromboplastin time [PTT], activated clotting time [ACT], and thromboelastography [TEG; Haemoscope] were collected from CABG (n = 99) and OPCAB (n = 98) patients. Residual heparin activity after protamine was measured, using an anti-activated factor X (Xa) assay, in 10 patients from each group. RESULTS: Our study showed that the current anticoagulation regimen in the OPCAB patients achieved a peak ACT of 445 +/- 73 s, and it preserved platelet counts and fibrinogen levels. A residual heparin effect was detected, with residual anti-Xa heparin activity of 0.2 U x ml(-1) up to 2 h after surgery in the OPCAB group. Despite the residual anticoagulation, the OPCAB group had a similar TEG index of native blood, postoperative chest tube drainage, and non-erythrocyte transfusion rate as compared with the CABG group. CONCLUSION: We have shown that the heparin anticoagulation regimen in OPCAB patients does not lead to an immediate hypercoagulable state. Total doses of heparin and protamine were lower in the OPCAB group compared with the CABG group, and there was a residual heparin effect on TEG and PTT in the early postoperative period in the OPCAB group.
Authors:
Kenichi A Tanaka; Vinod H Thourani; Willis H Williams; Peggy G Duke; Jerrold H Levy; Robert A Guyton; John D Puskas
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-08-01
Journal Detail:
Title:  Journal of anesthesia     Volume:  21     ISSN:  0913-8668     ISO Abbreviation:  J Anesth     Publication Date:  2007  
Date Detail:
Created Date:  2007-08-07     Completed Date:  2007-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8905667     Medline TA:  J Anesth     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  297-303     Citation Subset:  IM    
Affiliation:
Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, N.E., Atlanta, GA 30322, USA.
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MeSH Terms
Descriptor/Qualifier:
Aspirin / adverse effects,  pharmacology
Blood Coagulation / drug effects*
Blood Platelets / drug effects
Blood Transfusion / methods
Coronary Artery Bypass / adverse effects*,  methods
Coronary Artery Bypass, Off-Pump / adverse effects
Fibrinogen / drug effects
Fibrinolytic Agents / adverse effects,  pharmacology*
Heparin / adverse effects,  pharmacology*
Heparin Antagonists / administration & dosage
Humans
Platelet Count
Postoperative Hemorrhage / therapy*
Prospective Studies
Protamines / administration & dosage
Statistics, Nonparametric
Time Factors
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Heparin Antagonists; 0/Protamines; 50-78-2/Aspirin; 9001-32-5/Fibrinogen; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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