PERIOPERATIVE COURSE AND RECOVERY AFTER HEPARIN-COATED CARDIOPULMONARY BYPASS - LOW-DOSE VERSUS HIGH-DOSE HEPARIN MANAGEMENT

Objective: To compare two heparin managements for a cardiopulmonary by pass (CPB) procedure with heparin-coated equipment. The hypothesis was that a lower heparin dose may reduce blood loss and homologous transf usion requirements and influence the speed of postoperative recovery. Design: Prospective, randomized, and open study. Setting: Operating ro om and intensive care unit in a university hospital. Participants: Twe nty-four patients undergoing first-time elective coronary artery surge ry. Interventions: Heparin-coated CPB equipment (Duraflo II; Baxter-Be ntley) was used in all patients. The study group (n = 12) received low -dose (100 IU/kg IV and 0 to 1,000 IU/L priming; target level of activ ated coagulation time [ACT] over 180 seconds during CPB; suction in a red cell washing device); and the control group (n = 12) received high -dose (300 IU/kg IV and 5,000 IU/L priming; ACT over 480 seconds; stan dard cardiotomy suction) heparin management. Measurements and Main Res ults: ACT remained above 200 seconds after the initial heparin dose in the study group for the CPB duration up to 99 minutes. In 11 of 12 pa tients in the control group, additional heparin was required during CP B. Total doses of heparin and protamine (mean 8,017 v 50,508 IU and 83 V 325 mg, respectively; p < 0.0001), volume of homologous blood trans fusion (median 600 v 1450 mL; p < 0.025), and blood products exposure (median 0.5 v 5.0 units/patients; p < 0.05) were significantly lower i n the study group. Postoperative chest drainage showed a trend to lowe r volume loss (median 705 v 930 mL: p < 0.08) in patients managed with low-dose heparin. Oxygenator resistance during CPB, perioperative lab oratory analyses (oxygen and metabolic data, hematocrit, platelet coun t, prothrombin, thrombin, activated partial thromboplastin time, fibri nogen, D-dimers, creatine kinase, and myocardial band of creatine kina se concentration), fluid balance, and the time periods required for ex tubation, stay in the intensive care unit, and hospital discharge were not different between the groups. There were no evidences of myocardi al infarction in any of 24 patients, and all recovered after the proce dure. Conclusion: Low-dose heparin management enabled uneventful proce dures with heparin-coated CPB equipment, significantly decreased prota mine and homologous blood requirements, but did not reduce chest drain age or influence the postoperative course and recovery in patients aft er coronary artery surgery.