HEPARIN-BONDED CIRCUITS WITH A REDUCED ANTICOAGULATION PROTOCOL IN PRIMARY CABG - A PROSPECTIVE, RANDOMIZED STUDY

Background. A substantial proportion of patients undergoing primary co ronary revascularization require homologous transfusions. To address t his problem, a comprehensive strategy to diminish perioperative blood loss was developed. Methods. A prospective randomized trial was undert aken to test the hypothesis that ''tip-to-tip'' heparin-bonded cardiop ulmonary bypass circuits (HBC) can further enhance blood conservation and clinical outcomes in patients undergoing primary coronary artery b ypass grafting. Two hundred thirty-four patients were treated with eit her HBC and lower anticoagulation therapy (activated clotting time >28 0 seconds) or with conventional, nonheparin-bonded circuits and full a nticoagulation therapy (activated clotting time >480 seconds). Results . Preoperative and intraoperative risk profiles and characteristics we re similar in both groups, with 69.7% of the patients undergoing nonel ective coronary artery bypass grafting. Compared with the group with n onheparin-bonded circuits, patients treated with HBC had a lower chest tube output in the first 24 hours (561 +/- 257 versus 651 +/- 403; p = 0.04), were less likely to receive blood products (31.6% versus 47.9 %; p = 0.01), and required substantially fewer homologous donor units (1.98 +/- 4.8 versus 4.29 +/- 10.1; p = 0.029). Patients treated with HBC required a shorter duration of ventilatory support (13.2 +/- 16.9 versus 23.4 +/- 50.0 hours; p = 0.04), spent less time in the surgical intensive care unit (20.7 +/- 17.4 versus 35.5 +/- 61.7 hours; p = 0. 01), spent fewer days in the hospital (6.0 +/- 2.5 versus 7.3 +/- 5.2 days; p = 0.02), and had fewer postoperative complications (25.6% vers us 39.3%; p = 0.03). The use of HBC with a lower anticoagulation proto col was not associated with any adverse events. Conclusions. This stud y demonstrates that the use of HBC with a lower anticoagulation protoc ol in primary coronary artery bypass grafting safely and effectively r educes the incidence and magnitude of homologous transfusion, the dura tion of ventilation, and surgical intensive care unit and hospital sta ys.