Key result
Intermittent prebypass heparin dosing maintained better anticoagulation during cardiopulmonary bypass than a single dose, reducing the need for additional heparin (30% vs 60%).
Why the study?
Does intermittent prebypass heparin dosing improve haemostatic response and reduce the need for additional heparin in patients undergoing coronary artery bypass grafting?
Does intermittent prebypass heparin dosing improve haemostatic response and reduce the need for additional heparin in patients undergoing coronary artery bypass grafting?
Absolute Event Rate: 30% vs 60%
Intermittent prebypass heparin dosing may be more effective than a single bolus in maintaining adequate anticoagulation and preserving coagulation factors during cardiopulmonary bypass.
May support intermittent heparin dosing in CABG; hypothesis-generating from Level 3 data, needs RCTs before practice change.
In this study, 10 patients (Group B) were given three consecutive prebypass doses of heparin (100 IU/kg) with a 4 min interval prior to cardiopulmonary bypass (CPB) institution. They were compared with 10 patients (Group A) receiving the standard single prebypass heparin dose (300 IU/kg). The haemostatic response and anticoagulant monitoring during the perioperative period were investigated by point-of-care and several coagulation tests. Results of both groups were also correlated to blood loss. Three patients in Group B required additional heparin during bypass as compared with six patients in Group A. This suggests that intermittent prebypass heparin dosing is more effective in maintaining adequate levels of anticoagulation during CPB. Group B had a lower mean decrease in factor VIII (13.9% versus 43.2%), fibrinogen (38.5% versus 46.6%), antithrombin III (34.7% versus 40.1%) and platelet count (23.2% versus 28.9%) during bypass while only one unit of red cell concentrate was required postoperatively as compared with four units in Group A. In one patient, high fibrinolytic assays were associated with a haemorrhagic pericardial effusion occurring beyond 24 hours postsurgery.
No takes yet. Share an insight, caveat, or question.
Carmel Grima (2003) studied Coronary artery bypass grafting (n=20). Intermittent prebypass heparin dosing vs. Standard single prebypass heparin dose (300 IU/kg) was evaluated on Requirement for additional heparin during bypass. Intermittent prebypass heparin dosing maintained better anticoagulation during cardiopulmonary bypass than a single dose, reducing the need for additional heparin (30% vs 60%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: