How much heparin do we really need to go on pump? A rethink of current practices.
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Affiliation
Cork University Hospital, Cork, Ireland. msampca@msn.comIssue Date
2012-02-03T15:08:01ZMeSH
AgedAnticoagulants/*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
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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 SurgeryDOI
10.1016/j.ejcts.2004.07.009PubMed ID
15519187Abstract
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
engISSN
1010-7940 (Print)1010-7940 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1016/j.ejcts.2004.07.009
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