Key result
Early administration of antithrombin III combined with aminocaproic acid in heparin-resistant patients significantly reduced 24-hour chest tube drainage compared to standard heparin treatment (419.37 ml vs 782.88 ml, p=0.05).
Why the study?
Does antithrombin III reduce postoperative blood loss and complications in heparin-resistant patients undergoing cardiac surgery?
Cohort (n=311)
No
Does antithrombin III reduce postoperative blood loss and complications in heparin-resistant patients undergoing cardiac surgery?
Early identification and treatment of heparin-resistant cardiac surgery patients with antithrombin III and aminocaproic acid may decrease postoperative blood loss.
Answers are grounded in this paper and cite their sources.
May reduce postoperative bleeding in heparin-resistant cardiac surgery patients; hypothesis-generating and should not yet change practice.
A retrospective study examined the impact, in heparin resistant patients (HRP), of lyophilized antithrombin III (ATIII) upon five patient outcomes: intensive care unit stay (ICU-S), 24 hour chest tube drainage (CTD in ml), blood and blood product usage (BPU), development of post-operative coagulopathy (PO-Coag), and reoperation for bleeding (Re-Op). Data was collected from the medical records of 311 patients admitted to the hospital between 12/15/95 and 10/24/96. Subjects were divided into three groups based upon heparin resistance and hemostasis medication. Group 1 (n=l09) were HRP treated with increased heparin, Group 2 (n=100) were HRP receiving ATIII, and Group 3 (n=102) were non-HRP and served as controls. Group 2 was also subdivided by use of aminocaproic acid and time of ATIII administration. No significant differences were found between the groups for PO-Coag. and Re-Op. However, significant reduction in CTD (p=0.05) was seen in the aminocaproic acid patients who were treated with ATIII pre-CPB or within the first 20 minutes of CPB. The CTD in this group was (419.37, ± 72.96) as compared to Group 1 (782.88, ± 360.94) and Group 3 (766.67, ± 407.56). Other Group 2 subgroups showed significant differences in BPU, ICU-S and CTD. The results of this study support the notion that early identification and treatment of HRP with ATIII and aminocaproic acid may decrease postoperative blood loss.
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Conley et al. (1998) conducted a cohort in Heparin resistance during cardiac surgery (n=311). Antithrombin III vs. Increased heparin (Group 1) or non-heparin resistant controls (Group 3) was evaluated on 24-hour chest tube drainage (p=0.05). Early administration of antithrombin III combined with aminocaproic acid in heparin-resistant patients significantly reduced 24-hour chest tube drainage compared to standard heparin treatment (419.37 ml vs 782.88 ml, p=0.05).
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