HEART-TRANSPLANTATION UNDER COUMARIN THERAPY - FRIEND OR FOE

Thirty-six patients were included in a retrospective study of the effe ct of pre-operative anticogulant therapy on peri-operative blood loss and haemostatic changes after heart transplantation. Eleven patients ( group H) had received intravenous heparin for at least 3 weeks before cardiac transplantation. Twelve patients (group P) had been transplant ed when fully anticoagulated with phenprocoumon. A control group of 13 patients (group C) had undergone bypass grafting of their coronary ar teries with no pre-operative anticoagulant therapy. Post-operative dra inage from the chest drains was 700 ml (median) in group H, 425 ml in group P, and 360 ml in group C (group H vs. group C: P<0.05). After he parinization for cardiopulmonary bypass, activated clotting time was 4 62 s (median) in group H, 1500 s in group P, and 727 s in group C (P<0 .003 vs. groups H and P). Postoperatively, patients in group P were gi ven more units of fresh frozen plasma (median 2.5 units; P<0.01), prot hrombin complex concentrate (median 1000 I.U.; P<0.05) and vitamin K ( median 10 mg; P<0.05) than groups H and C. Heart transplantation under full phenprocoumon therapy does not increase the likelihood of compli cations caused by peri-operative bleeding.