Gabexate mesilate and antithrombin III for intraoperative anticoagulation in heparin pretreated patients

Thirty patients scheduled for elective myocardial revascularization and hav ing undergone preoperative heparin treatment have been admitted to this pro spective, randomized study. The aim of the study was to test two different strategies for preserving circulating antithrombin III (AT-III) during card iopulmonary bypass. Patients in the control group (group C, n = 10) were tr eated with a standard heparinization (300 IU/kg). Patients in group A (n = 10) received the same management plus two doses of purified antithrombin II I (1000 IU each). Patients in group GA received 200 IU/kg heparin and a con tinuous infusion of heparin (100 IU/kg/h) and gabexate mesilate (2 mg/kg/h) plus the same dose of antithrombin III as group A. Both group A and group GA demonstrated a preservation of circulating AT-III when compared to group C; this effect was more pronounced in group GA. The total heparin dosage w as less in group GA than in groups A and C. Purified AT-III administration is recommended in heparin pretreated patients; the addition of gabexate mes ilate to this protocol decreases the heparin requirement and increases the AT-III preservation.