More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT

Thrombosis and Haemostasis

Volumn 76, Issue 6, 1996, Pages 902-908

  Despotis, George J ^a   Heinrich Joist, J ^b   Hogue Jr , Charles W ^a   Alsoufiev, Alexander ^a   Joiner Maier, D ^b   Santoro, Samuel A ^a   Spitznagel, Edward ^c   Weitz, Jeffrey I ^d   Goodnough, Lawrence T ^a  

^a WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c WASHINGTON UNIVERSITY   (United States)

^d MCMASTER UNIVERSITY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBODY; ANTIPLASMIN; ANTITHROMBIN; ANTITHROMBIN III; BLOOD CLOTTING FACTOR 10A; BLOOD CLOTTING FACTOR 5; BLOOD CLOTTING FACTOR 8; COMPLEMENT COMPONENT C3; D DIMER; FIBRIN DEGRADATION PRODUCT; FIBRINOGEN; FIBRINOPEPTIDE A; HEPARIN; HEPARIN COFACTOR II; INFUSORIAL EARTH; KAOLIN; PLASMIN; PROTAMINE; PROTHROMBIN;

ADULT; AGED; ARTICLE; BLEEDING; BLEEDING TIME; BLOOD CLOT; BLOOD CLOTTING TIME; CARDIOPULMONARY BYPASS; CLINICAL ARTICLE; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DRUG BLOOD LEVEL; FEMALE; FIBRINOGEN BLOOD LEVEL; HEART SURGERY; HEMOSTASIS; HUMAN; MALE; PATIENT MONITORING; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; THROMBOSIS;

EID: 8044257128     PISSN: 03406245     EISSN: None     Source Type: Journal    
DOI: 10.1055/s-0038-1650684     Document Type: Article

References (58)

1. Ottesen S, Stormorken H, Hatteland K. The value of activated coagulation time in monitoring heparin therapy during extracorporeal circulation. Scand J Thorac Cardiovasc Surg 1984; 18: 123-8.
2. Metz S, Keats AS. Low activated coagulation time during cardiopulmonary bypass does not increase postoperative bleeding. Ann Thorac Surg 1990; 49: 440-4.
3. Kesteven PJ, Pasaoglu I, Williams BT, Savidge GF. Significance of the whole blood activated clotting time in cardiopulmonary bypass. J Cardiovasc Surg 1986; 27: 85-9.
4. Culliford AT, Gitel SN, Starr N, Thomas ST, Baumann FG, Wessler S, Spencer FC. Lack of correlation between activated clotting time and plasma heparin during cardiopulmonary bypass. Annals of Surgery 1981; 193: 105-11.
5. Cohen EJ, Cameriengo LJ, Dearing JP. Activated clotting times and cardiopulmonary bypass. I. The effect of hemodilution and hypothermia upon activated clotting time. JECT 1980; 12: 139-41.
6. Despotie GJ, Summerfield AL, Joist JH, Foodnough LT, Santoro SA, Spitznagel E, Cox JL, Lappas DG. Comparison of activated coagulation time and whole blood heparin measurements with laboratory plasma anti-Xa heparin concentration in patients having cardiac operations. J Thorac Cardiovasc Surg 1994; 108: 1076-82.
7. Slaughter TF, Le Bleu TH, Douglas JM Jr, Leslie JB, Parker JK, Greenberg CS. Characterization of prothrombin activation during cardiac surgery by hemostatic molecular markers. Anesthesiology 1994; 80: 520-6.
8. Jobes DR, Schwartz AJ, Ellison N, Andrews R, Ruffini RA, Ruffini JJ. Monitoring heparin anticoagulation and its neutralization. Ann Thorac Surg 1981; 31: 161-6.
9. Gravlee GP, Rogers AT, Dudas LM, Taylor R, Roy RC, Case LD, Triscott M, Brown CW, Mark LJ, Cordell AR. Heparin management protocol for cardiopulmonary bypass influences postoperative heparin rebound but not bleeding. Anesthesiology 1992; 76: 393-401.
10. Gravlee GP, Haddon WS, Rothberger HK, Mills SA, Rogers AT, Bean VE, Buss DH, Prough DS, Cordell AR. Heparin dosing and monitoring for cardiopulmonary bypass. A comparison of techniques with measurement of subclinical plasma coagulation. J Thorac Cardiovasc Surg 1990; 99: 518-27.
11. Fox DJ, Gaines J, Reed G. Vehicles of heparin management: A comparison. J Exp Corp Tech 1979; 11: 137-41 (Abstract).
12. Harloff M, Taraskiewicz, Fotouhi C. Comparison study of the hepcon system four and the hemostasis management system, perfusion 1991; 6: 297-301.
13. Hashimoto K, Yamagishi M, Sasaki T, Nakano M, Kurosawa H. Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation. Ann Thorac Surg 1995; 58: 799-805.
14. Weitz JI, Hudoba M, Massel D, Maraganore J, Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors. J Clin Invest 1990; 86: 385-91.
15. Tollefsen FA, Fernandez F, Gauthier D, Buchanan MR. Heparin cofactor II and other endogenous factor in the mediation of the antithrombotic and anticoagulant effects of heparin and dermatan sulfate. Semin Thromb Hemost 1985; 86: 385-91.
16. Despotis GJ, Joist JH, Hogue CW, Alsoufiev A, Kater K, Goodnough LT, Santoro SA, Spitznagel E, Rosenblum M, Lappas DG. The impact of heparin concentration and activated clotting time monitoring on blood conservation: a prospective, randomized evaluation in patients undergoing cardiac operations. J Thorac Cardiovasc Surg 1995; 110: 46-54.
17. Despotis GJ, Santoro SA, Spitznagel E, Kater KM, Cox JL, Barnes P, Lappas DG. Prospective evaluation and clinical utility of on-site monitoring of coagulation in patients undergoing cardiac operation. J Thorac Cardiovasc Surg 1994; 107: 271-9.
18. Khuri SF, Wolfe JA, Josa M, Axford TC, Szymanski I, Assousa S, Ragno G, Patel M, Silverman A, Park M. Hematologic changes during and after cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical blood loss. J Thorac Cardiovasc Surg 1992; 104: 94-107.
19. Babson SR, Babson AL. Development and evaluation of a disposable device for performing simultaneous duplicate bleeding time determinations. Am J Clin Pathol 1978; 70: 406-8.
20. Hirsh J. Heparin. [Review]. N Engl J Med 1991; 324: 1565-74.
21. Esposito RA, Culliford AT, Colvin SB, Thomas SJ, Lackner H, Spencer FC. Heparin resistance during cardiopulmonary bypass. The role of heparin pretreatment. J Thorac Cardiovasc Surg 1983; 85: 346-53.
22. Hill JD, Dontigny L, De Leval M, Mielke CH Jr. A simple method of heparin management during prolonged extracorporeal circulation. Ann Thorac Surg 1974; 17: 129-34.
23. Verska JJ. Control of heparinization by activated clotting time during bypass with improved postoperative hemostasis. Ann Thorac Surg 1977; 24: 170-3.
24. Babka R, Colby C, El-Etr A, Pifarre R. Monitoring of intraoperative heparinization and blood loss following cardiopulmonary bypass surgery. J Thorac Cardiovasc Surg 1977; 73: 780-2.
25. Bull BS, Korpman RA, Huse WM, Briggs BD. Heparin therapy during extracorporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg 1975; 69: 674-84.
26. Akl BF, Vargas GM, Neal J, Robillard J, Kelly P. Clinical experience with the activated clotting time for the control of heparin and protamine therapy during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1980; 79: 97-102.
27. Umlas J, Gauvin G, Taff R. Heparin monitoring and neutralization during cardiopulmonary bypass using a rapid plasma separator and a fluorometric assay. Ann Thorac Surg 1984; 37: 301-3.
28. Stenbjerg S, Berg E, Albrechtsen OK. Heparin levels and activated clotting time (ACT) during open heart surgery. Scand J Haematol 1981; 26: 281-4.
29. Gravlee GP. Anticoagulation for cardiopulmonary bypass. In: Cardiopulmonary Bypass: Principles and Practice. Gravlee GP, Utley RF, eds. Baltimore: Williams & Wilkens 1993: pp 340-80.
30. Moorehead MT, Westengard JC, Bull BS. Platelet involvement in the activated coagulation lime of heparinized blood. Anesth Analg 1984; 63: 394-8.
31. Jobes DR, Schaffer GW, Aitken GL. Increased accuracy and precision of heparin and protamine dosing reduces blood loss and transfusion in patients undergoing primary cardiac operations. J Thorac Cardiovasc Surg 1995; 110: 36-45.
32. Saleem A, Shenaq SS, Yawn DH, Harshberger K, Diemunsch P, Mohindra P. Heparin monitoring during cardiopulmonary bypass. Ann Clin Lab Sci 1984; 14: 474-9.
33. Boldt J, Schindler E, Osmer C, Wittstock M, Stertmann WA, Hempelmann G. Influence of different anticoagulation regimens on platelet function during cardiac surgery. Br J Anaesth 1994; 73: 639-44.
34. Despotis GJ, Filos KS, Zoys TN, Hogue CWJ, Spitznagel E, Lappas DG. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: A multivariate analysis in cardiac surgical patients. Anesth Analg 1996; 82: 13-21.
35. Thomas DP, Barrowcliffe TW, Johnson EA. The influence of tissue source, salt and molecular weight and heparin activity. [Review]. Scand J Haematol Suppl 1980; 36: 40-9.
36. Rinder CS, Bohnert J, Rinder HM, Mitchell J, Ault K, Hillman R. Platelet activation and aggregation during cardiopulmonary bypass. Anesthesiology 1991; 75: 388-93.
37. Addonizio VP Jr, Colman RW, Edmunds LH Jr. The effect of blood flow rate and circuit surface area on platelet loss during extracorporeal circulation. Trans Am Soc Artif Intern Organs 1978; 24: 650-5.
38. Despotis FJ, Grishaber JE, Goodnough LT. The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery. Transfusion 1994; 34: 290-6.
39. Van der Graaf F, Keus FJ, Vlooswijk RA, Bouma BN. The contact activation mechanism in human plasma: activation induced by dextran sulfate. Blood 1982; 59: 1225-33.
40. Heimark RL, Kurachi K, Fujikawa K, Davie EW. Surface activation of blood coagulation, fibrinolysis and kinin formation. Nature 1980; 286: 456-60.
41. Boisclair MD, Lane DA, Philippou H, Esnouf MP, Sheikh S, Hunt B, Smith KJ. Mechanisms of thrombin generation during surgery and cardiopulmonary bypass. Blood 1993; 82: 3350-7.
42. Holloway DS, Summaria L, Sandesara J, Vagher JP, Alexander JC, Caprini JA. Decreased platelet number and function and increased fibrinolysis contribute to postoperative bleeding in cardiopulmonary bypass patients. Thromb Haemost 1988; 59: 62-7.
43. Tabuchi N, de Haan J, Boonstra PW, van Oeveren W. Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993; 106: 828-33.
44. Gram J, Janetzko T, Jespersen J, Bruhn HD. Enhanced effective fibrinolysis following the neutralization of heparin in open heart surgery increases the risk of post-surgical bleeding. Thromb Haemost 1990; 63: 241-5.
45. Young JA, Kisker CT, Doty DB. Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann Thorac Surg 1978; 26: 231-40.
46. Dietrich W, Dilthey G, Spannagl M, Jochum M, Braun SL, Richter JA. Influence of high-dose aprotinin on anticoagulation, heparin requirement, and celite- and kaolin-activated clotting time in heparin-pretreated patients undergoing open-heart surgery. Anesthesiology 1995; 83: 679-89.
47. Dietrich W, Spannagl M, Schramm W, Vogt W, Barankay A, Richter JA. The influence of preoperative anticoagulation on heparin response during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 102: 505-14.
48. Abildgaard U. Heparin/low molecular weight heparin and tissue factor pathway inhibitor. [Review]. Haemostasis 1993; 23 (Suppl 1): 103-6.
49. Lindahl AK, Abildgaard U, Staalesen R. The anticoagulant effect in heparinized blood and plasma resulting from interactions with extrinsic pathway inhibitor. Thromb Res 1991; 64: 155-68.
50. Salzman EW, Rosenberg RD, Smith MH, Lindon JN, Favreau L. Effect of heparin and heparin fractions on platelet aggregation. [Review]. J Clin Invest 1980; 65: 64-73.
51. Holmer E, Lindahl U, Backstrom G, Thunberg L, Sandberg H, Soderstrom G, Anderson LO. Anticoagulant activities and effects on platelets of a heparin fragment with high affinity for antithrombin. Thromb Res 1980; 18: 861-9.
52. Fernandez F, N'guyen P, Van Ryn J, Ofosu FA, Hirsh J, Buchanan MR. Hemorrhagic doses of heparin and other glycosaminoglycans induce a platelet defect. Thromb Res 1986; 43: 491-5.
53. John LC, Rees GM, Kovacs IB. Inhibition of platelet function by heparin. An etiologic factor in postbypass hemorrhage. J Thorac Cardiovasc Surg 1993; 105: 816-22.
54. Suzuki K, Nishioka J, Hashimoto S. Inhibition of factor VIII-associated platelet aggregation by heparin and dextran sulfate, and its mechanism. Biochim Biophys Acta 1979; 585: 416-26.
55. Sobel M, McNeill PM, Carlson PL, Kermode JC, Adelman B, Conroy R, Marques D. Heparin inhibition of von Willebrand factor-dependent platelet function in vitro and in vivo. Journal of Clinical Investigation 1991; 87: 1787-93.
56. Guffin AV, Dunbar RW, Kaplan JA, Bland JW Jr. Successful use of a reduced dose of protamine after cardiopulmonary bypass. Anesth Analg 1976; 55: 110-3.
57. Shastri KA, Logue GL, Stern MP, Raza S, O'Connor BM, Bovill JJ, Hoover EL. Neutrophil lactoferrin release during open heart surgery is unrelated to complement activation. ASAIO J 1994; 40: 56-61.
58. Moorman RM, Zapol WM, Lowenstein E. Neutralization of Heparin Anticoagulation. In: Cardiopulmonary Bypass: Principles and Practice. Gravlee GP, Utley RF, eds. Baltimore: Williams & Wilkens 1993: pp 381-2.