Key result
Heparin administration during cardiopulmonary bypass resulted in an approximate twofold increase in VIIa-antithrombin complexes from a presurgery median of 52.7 pM to 110 pM.
Why the study?
Does heparin administration during cardiopulmonary bypass increase VIIa-antithrombin complex concentrations in adult patients undergoing cardiac surgery?
Observational (n=13)
Does heparin administration during cardiopulmonary bypass increase VIIa-antithrombin complex concentrations in adult patients undergoing cardiac surgery?
Heparin administration during cardiopulmonary bypass leads to a twofold increase in VIIa-antithrombin complexes, suggesting antithrombin actively inhibits VIIa during cardiac surgery.
Heparin during CPB may enhance antithrombin-mediated VIIa inhibition; hypothesis-generating for hemostatic effects and should not yet change practice.
Antithrombin inhibits VIIa when bound to cellular tissue factor in the presence of heparin. VIIa concentrations increase within the surgical field during cardiopulmonary bypass surgery but decrease when measured in the patient. Using a new ELISA (Stago, Reading, UK), we measured VIIa-antithrombin complexes in patients undergoing cardiopulmonary bypass to determine whether antithrombin plays a physiological role in VIIa inhibition during cardiac surgery. Samples were taken from 13 adult patients undergoing cardiac surgery with cardiopulmonary bypass at the following time points: presurgery, postheparin, 20 min intervals during cardiopulmonary bypass and postprotamine. The presurgery concentrations of VIIa-antithrombin complexes were median of 52.7pm, and these rose postheparin bolus to a median of 110pM that was maintained throughout cardiopulmonary bypass and postprotamine administration. There is an approximate twofold increase in measurable VIIa-antithrombin complexes in patients undergoing cardiac surgery, which is apparent after heparin administration. Antithrombin appears to play an active role in VIIa inhibition during cardiac surgery.
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Davidson et al. (2011) conducted an observational in Cardiac surgery with cardiopulmonary bypass (n=13). Heparin administration during cardiopulmonary bypass vs. Presurgery baseline was evaluated on VIIa-antithrombin complex concentrations (approximate twofold increase). Heparin administration during cardiopulmonary bypass resulted in an approximate twofold increase in VIIa-antithrombin complexes from a presurgery median of 52.7 pM to 110 pM.
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