How much heparin do we really need to go on pump? A rethink of current practices.

Hdl Handle:
http://hdl.handle.net/10147/208941
Title:
How much heparin do we really need to go on pump? A rethink of current practices.
Authors:
Shuhaibar, M N; Hargrove, M; Millat, M H; O'Donnell, A; Aherne, T
Affiliation:
Cork University Hospital, Cork, Ireland. msampca@msn.com
Citation:
Eur J Cardiothorac Surg. 2004 Nov;26(5):947-50.
Journal:
European journal of cardio-thoracic surgery : official journal of the European, Association for Cardio-thoracic Surgery
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208941
DOI:
10.1016/j.ejcts.2004.07.009
PubMed ID:
15519187
Abstract:
OBJECTIVES: Patients undergoing myocardial revascularisation using extracorporeal circulation require heparin anticoagulation. We aimed to evaluate the effect of reducing heparin dosage on target activated clotting time (ACT) and postoperative blood loss. METHODS: In a prospective randomised trial, 195 patients undergoing isolated primary CABG were randomised into four groups A, B, C, and D receiving an initial heparin dosage of 100, 200, 250 and 300 iu/kg, respectively. Extra incremental heparin (50 iu/kg) was added if required to achieve a target ACT of 480 s before initiating cardiopulmonary bypass. Postoperative blood loss was measured from the time of heparin reversal to drain removal 24h later. RESULTS: Target ACT was achieved in 0, 63, 68.3 and 82.4% of patients in groups A, B, C and D, respectively, after the initial dose of heparin. In group B, of those not achieving target act a single increment of heparin was sufficient to achieve target ACT in further 18.6%. The mean ACT after the initial dose in groups B, C and D was 482.9, 519 and 588 s, respectively (P<0.05). Postoperative blood loss in millilitre per kilogram was directly proportional to preoperative heparin dose. CONCLUSIONS: Patients receiving lower dose of heparin has lower postoperative blood loss. Of those achieving the target ACT, group B was significantly the closest to the target ACT. A starting dose of 200 iu/kg of heparin and if necessary one 50 iu/kg increment achieved target ACT in 81.5% of patients. The added benefit of significant drop in postoperative blood loss is evident.
Language:
eng
MeSH:
Aged; Anticoagulants/*administration & dosage/adverse effects; Blood Coagulation/drug effects; *Cardiopulmonary Bypass; Coronary Artery Bypass; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Heparin/*administration & dosage/adverse effects; Humans; Intraoperative Care/methods; Male; Middle Aged; Postoperative Hemorrhage/*chemically induced; Prospective Studies; Whole Blood Coagulation Time
ISSN:
1010-7940 (Print); 1010-7940 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorShuhaibar, M Nen_GB
dc.contributor.authorHargrove, Men_GB
dc.contributor.authorMillat, M Hen_GB
dc.contributor.authorO'Donnell, Aen_GB
dc.contributor.authorAherne, Ten_GB
dc.date.accessioned2012-02-03T15:08:01Z-
dc.date.available2012-02-03T15:08:01Z-
dc.date.issued2012-02-03T15:08:01Z-
dc.identifier.citationEur J Cardiothorac Surg. 2004 Nov;26(5):947-50.en_GB
dc.identifier.issn1010-7940 (Print)en_GB
dc.identifier.issn1010-7940 (Linking)en_GB
dc.identifier.pmid15519187en_GB
dc.identifier.doi10.1016/j.ejcts.2004.07.009en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208941-
dc.description.abstractOBJECTIVES: Patients undergoing myocardial revascularisation using extracorporeal circulation require heparin anticoagulation. We aimed to evaluate the effect of reducing heparin dosage on target activated clotting time (ACT) and postoperative blood loss. METHODS: In a prospective randomised trial, 195 patients undergoing isolated primary CABG were randomised into four groups A, B, C, and D receiving an initial heparin dosage of 100, 200, 250 and 300 iu/kg, respectively. Extra incremental heparin (50 iu/kg) was added if required to achieve a target ACT of 480 s before initiating cardiopulmonary bypass. Postoperative blood loss was measured from the time of heparin reversal to drain removal 24h later. RESULTS: Target ACT was achieved in 0, 63, 68.3 and 82.4% of patients in groups A, B, C and D, respectively, after the initial dose of heparin. In group B, of those not achieving target act a single increment of heparin was sufficient to achieve target ACT in further 18.6%. The mean ACT after the initial dose in groups B, C and D was 482.9, 519 and 588 s, respectively (P<0.05). Postoperative blood loss in millilitre per kilogram was directly proportional to preoperative heparin dose. CONCLUSIONS: Patients receiving lower dose of heparin has lower postoperative blood loss. Of those achieving the target ACT, group B was significantly the closest to the target ACT. A starting dose of 200 iu/kg of heparin and if necessary one 50 iu/kg increment achieved target ACT in 81.5% of patients. The added benefit of significant drop in postoperative blood loss is evident.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnticoagulants/*administration & dosage/adverse effectsen_GB
dc.subject.meshBlood Coagulation/drug effectsen_GB
dc.subject.mesh*Cardiopulmonary Bypassen_GB
dc.subject.meshCoronary Artery Bypassen_GB
dc.subject.meshDose-Response Relationship, Drugen_GB
dc.subject.meshDrug Administration Scheduleen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHeparin/*administration & dosage/adverse effectsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIntraoperative Care/methodsen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPostoperative Hemorrhage/*chemically induceden_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshWhole Blood Coagulation Timeen_GB
dc.titleHow much heparin do we really need to go on pump? A rethink of current practices.en_GB
dc.contributor.departmentCork University Hospital, Cork, Ireland. msampca@msn.comen_GB
dc.identifier.journalEuropean journal of cardio-thoracic surgery : official journal of the European, Association for Cardio-thoracic Surgeryen_GB
dc.description.provinceMunster-

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