Key result
Heparin resistance during on-pump CABG was associated with significantly higher rates of re-exploration for bleeding (30.0% vs 5.5%), acute kidney injury, and blood product use, without increasing mortality.
Why the study?
Does heparin resistance lead to poor early postoperative outcomes in patients undergoing on-pump coronary artery bypass grafting?
Observational (n=300)
No
Does heparin resistance lead to poor early postoperative outcomes in patients undergoing on-pump coronary artery bypass grafting?
Absolute Event Rate: 30% vs 5.5%
p-value: p=0.003
Heparin resistance during on-pump CABG occurs in approximately 10% of patients and is associated with increased postoperative morbidity, including bleeding and acute kidney injury, but not mortality in lower-risk patients.
May warrant closer monitoring for bleeding in heparin-resistant on-pump CABG patients; leaves open need for targeted interventions in future trials.
Background: Heparin resistance (HR) is a well-known phenomenon inpatients undergoing cardiac surgery. Its effect on outcome has not been studied well. StudyDesign: Prospective observational study. Setting: Department of Cardiac Surgery, PunjabInstitute of Cardiology Lahore. Period: April 2013 to March 2015. Materials and Methods:The study included 300 consecutive patients undergoing on pump coronary artery bypassgrafting (CABG). Those with severe left ventricular dysfunction, multiple cardiac proceduresand emergency CABG were excluded from the study. Data was collected on proformas withperioperative variables. The data was analyzed using Statistical Package for Social Sciencesversion 10. Results: A total of 300 patients were included in the study. This included 60(20%)female patients. The mean age of the patients was 50.76 ±4.67 years. Out of the studied cohort,30(10%) patients showed heparin resistance. Clinical characteristics i.e. hypertension, diabetesmellitus, smoking, hyperlipidaemias and obesity did not show any significance when patientswith and without heparin resistance were compared. Total drain was significantly more in group1 (700±150.13 ml) compared to group 2 (500±120.33 ml) with p=0.023. Similarly, renal failurein group 1 vs group 2 (30.0% vs 15.4%. p=.017), use of blood products more than two units ingroup 1 vs group 2 (83.30% vs 10.7%, p= .003), re-exploration for bleeding in group 1 vs group2 (30.0% vs 5.5%, p=.003) was significantly more in group 1 vs group 2 respectively. Mortalitywas insignificant in both groups. Conclusion: Heparin resistance occurred in 10% of thepatients. Patients with heparin resistance lead to poor postoperative outcomes like increasedrenal failure, bleeding, rate of re-exploration and increased use of blood products but does notlead to increased mortality in patient with comparatively lower risk profile.
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Khan et al. (2018) conducted an observational in Coronary artery disease requiring CABG (n=300). Heparin resistance vs. No heparin resistance was evaluated on Re-exploration for bleeding (p=0.003). Heparin resistance during on-pump CABG was associated with significantly higher rates of re-exploration for bleeding (30.0% vs 5.5%), acute kidney injury, and blood product use, without increasing mortality.
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