Heparin coating of the extracorporeal circuit combined with leukocyte filtration reduces coagulation activity, blood loss and blood product substitution

Background: Cardiopulmonary bypass is associated with activation of the coa gulation cascade. Occasionally, this results in postoperative hemorrhage an d consequently the need for blood products associated with increasing costs and risk of infection. Contact activation of the intrinsic coagulation pat hway, and damage to cellular blood components with the release of proteolyt ic substances from neutrophil granulocytes have been linked to these coagul ation disorders. Methods: Eighteen routine CABG-patients were randomly assigned to totally h eparin coated circuits (Bioline coating) combined with leukocyte filtration in a double blind protocol (group I), 34 patients served as controls (grou p II). Leukocyte filters were activated before release of the aortic crossc lamp. Coagulation activity, postoperative blood loss, and substitution with blood products were assessed. Results: Blood loss in the first 24h after surgery was significantly lower with combined application of heparin coating and leukocyte filters (group I ) vs. controls (group II) (526+/-78ml vs. 786+/-88ml; p<0.05). Thrombin for mation represented by prothrombin fragments 1+2 was significantly lower in group I vs. group II after declamping of the aorta (2.1+/-0.3nmol/L vs. 4.0 +/-0.3 nmol/L; p<0.05). Group I showed higher AT III plasma than group II ( 48.8+/-3.2% vs. 41.5+/-1.7%; p<0.05). Conclusions: Leukocyte filtration during reperfusion in heparin coated card iopulmonary bypass circuits is associated with lower coagulation activation , decreased blood loss and reduced transfusion of packed red cells in elect ive CABG patients.