EFFECTIVE USE OF HEPARIN-BONDED CIRCUITS AND LOWER ANTICOAGULATION FOR CORONARY-ARTERY BYPASS-GRAFTING IN JEHOVAH-WITNESSES

Despite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascularization s till require homologous transfusions. Based on a large clinical experi ence with high-risk patients during coronary artery bypass, a comprehe nsive strategy to diminish perioperative blood loss was developed by i ntegrating many individual components. An integral component in this s trategy is the use of lower heparinization (activated clotting time [A CT] > 280 sec) in conjunction with ''tip-to-tip'' heparin-bonded cardi opulmonary bypass (CPB) circuits (HBC). This technique was prospective ly applied to a group of Jehovah's Witnesses (JW) patients who refuse blood transfusion on religious grounds (n = 9). Outcome was compared t o a matched group of patients treated with full heparinization (ACT > 480 sec) used with conventional, nonheparin-bonded CPB circuits (NHBC) performed within the same academic year (n = 455). There were no comp lications in JW patients who had a significantly lower mediastinal and pleural tube output in the first 24 hours (323 67 mL vs 984 616 mL, p < 0.01). In comparison to JW patients who received no transfusions, 6 8.1% of patients treated with NHBC were transfused (p 0.0001). In summ ary, HBC in conjunction with lower anticoagulatlon was effectively and safely applied to JW patients undergoing coronary artery bypass graft ing. This technique should be considered for broader clinical use.