Heparin pretreatment does not alter heparin requirements during cardiopulmonary bypass

Heparin infusion may cause heparin resistance and may affect monitoring by measurement of the activated coagulation time (ACT), making the assessment of anticoagulation difficult, with the risk of over- or undertreatment, especially during cardiac surgery. We studied two groups of patients undergoin...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2001-12, Vol.87 (6), p.844-847
Main Authors: Nicholson, S.C., Keeling, D.M., Sinclair, M.E., Evans, R.D.
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia
Anesthesia depending on type of surgery
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anticoagulants - administration & dosage
Antithrombins - metabolism
Biological and medical sciences
Blood Coagulation - drug effects
blood, anticoagulants, heparin
blood, antithrombin
Blood. Blood coagulation. Reticuloendothelial system
Cardiopulmonary Bypass
Drug Administration Schedule
Drug Resistance
Heparin - administration & dosage
Humans
Intraoperative Care
Medical sciences
Middle Aged
Monitoring, Intraoperative
Pharmacology. Drug treatments
Preoperative Care - methods
surgery, cardiovascular
Thoracic and cardiovascular surgery. Cardiopulmonary bypass
Whole Blood Coagulation Time
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Summary:Heparin infusion may cause heparin resistance and may affect monitoring by measurement of the activated coagulation time (ACT), making the assessment of anticoagulation difficult, with the risk of over- or undertreatment, especially during cardiac surgery. We studied two groups of patients undergoing cardiopulmonary bypass (CPB): patients on heparin infusions (group H) and heparin-naive controls (group C). All patients received heparin 300 IU kg−1 before CPB and a further dose of 5000 IU if the ACT 5 min after commencing bypass was less than 400 s. Measurements of ACT, heparin concentration, antithrombin-3, thrombin–antithrombin complex, prothrombin fragment F1+2 and D-dimers were made before and 5 and 20 min after start of CPB. A second dose of heparin was given to eight out of 18 patients in group C and 10 out of 24 in group H. Antithrombin-3 in group H was significantly less than in group C at 5 min [59 (14) vs 52 (9)%, P
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/87.6.844