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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2001 Ottobre;42(5):579-85

CARDIAC SECTION 

 ORIGINAL ARTICLES

Low dose systemic heparinization combined with heparin-coated extracorporeal circulation. Effects related to platelets

Mirow N., Brinkmann T. *, Minami K., Tenderich G., Schulte-Eistrup S., Kleesiek K. *, Körfer R.

From ­the Clinic ­for Thoracic ­and Cardiovascular Surgery
*Institute ­for Laboratory ­and Transfusion Medicine, Heart Center ­NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany

Background. A hep­ar­in coat­ed car­di­o­pul­mo­nary ­bypass ­system com­bined ­with ­full ­and ­low ­dose system­ic hep­a­rin­iza­tion in cor­o­nary ­bypass sur­gery ­was inves­ti­gat­ed in a pros­pec­tive, ran­dom­ised ­study. Roller ­pumps, cor­o­nary suc­tion ­and an ­open car­di­ot­o­my res­er­voir ­were ­used.
Methods. One hundred and nineteen ­patients ­were divid­ed ­into 3 ­groups: ­group A (n=39) ­had a stan­dard uncoat­ed extra­cor­po­real cir­cu­la­tion (­ECC)-­set ­and system­ic hep­ar­in ­was giv­en in an ­initial ­dose of 400 IE/kg ­body ­weight. During ­ECC acti­vat­ed clot­ting ­time (­ACT) ­was ­kept at ≥480 sec. Group B (n=42) ­had ­the ­same ­ECC-­set com­plete­ly coat­ed ­with ­low molec­u­lar ­weight hep­ar­in, i.v. hep­ar­in ­was admin­is­tered in ­the ­same ­dose as in ­group A, ­ACT ­was ­again ­kept at ≥480 ­sec. Group C (n=38) ­had ­the ­same coat­ed ­ECC ­set ­as ­group B, ­but i.v. hep­ar­in ­was ­reduced to 150 IE/kg ­and dur­ing ­ECC ­ACT ­was maintained of ≥240 ­sec.
Results. Platelet ­decrease ­was sig­nif­i­cant­ly ­less in ­both ­groups uti­liz­ing coat­ed cir­cuit­ry as com­pared to con­trol ­group A. Activation of throm­boc­y­tes as ­marked by β-throm­bo­glob­u­lin (­not PF4) ­was sig­nif­i­cant­ly ­decreased in ­patients treat­ed ­with coat­ed cir­cuits com­bined ­with ­low ­dose system­ic hep­a­rin­iza­tion ­and post­op­er­a­tive bleed­ing ­was sig­nif­i­cant­ly ­reduced.
Conclusions. We con­clude ­that in hep­ar­in coat­ed extra­cor­po­real cir­cu­la­tion com­bined ­with ­either ­full ­dose or ­reduced system­ic hep­a­rin­iza­tion com­pared to uncoat­ed cir­cuits plate­let ­count reduc­tion is sig­nif­i­cant­ly ­less. Platelet acti­va­tion as ­marked by β-throm­bo­glob­u­lin ­and post­op­er­a­tive ­blood ­loss ­are ­decreased ­with coat­ed equip­ment ­and ­low i.v. hep­a­rin­iza­tion.

lingua: Inglese


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