A comparison of low vs conventional‐dose heparin for minimal cardiopulmonary bypass in coronary artery bypass grafting surgery

Fromes, Yves; Daghildjian, K.; Caumartin, L.; Fischer, Marc; Rouquette, Isabelle; Deleuze, Philippe; Bical, O

doi:10.1111/j.1365-2044.2011.06709.x

Cited by 22 publications

(12 citation statements)

References 19 publications

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“…We found the initial dose of heparin calculated using our formula to be lower than that calculated using the conventional formula, which considers only BW. The rate of target ACT achievement using our formula was 86.4%, which was comparable to Shuhaibar's report of an 82.4% achievement rate using the conventional dose of 300 IU/kg heparin [5]. Our results suggest the possibility that the conventional dose of heparin may be excessive and our formula is useful with respect to target ACT achievement.…”

Section: Discussionsupporting

confidence: 78%

“…In fact, the ACT value after the administration of initial dose of heparin (300 IU/kg) was sometimes beyond our expectation. Heparin overdose has been reported to be associated with significantly increased postoperative blood loss [4] and/or a longer intensive care unit stay [5] [6]. When an overdose of heparin is administered, the ACT value is likely to increase again after surgery [7]- [9].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a New Formula for Calculating Heparin Dose for Cardiopulmonary Bypass Patients

Nakasuji¹,

Matsushita²,

Inaba³

et al. 2014

OJTS

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Introduction: Anticoagulation is essential during CPB in cardiac surgery. It is generally performed using heparin; however the widely used formula for its dosing is based solely on body weight. Although the formula assumes activated clotting time (ACT) to be within normal range, baseline ACT varies in each patient. Thus, we developed an original formula, which takes into account baseline ACT in addition to body weight to calculate a more proper dose for initial administration of heparin. In this study, we monitored the ACT to examine if the dose of heparin calculated using our formula can prolong the ACT to the target range, and we determined the factors which interfere with the prolongation of ACT. Methods: Between October 2010 and April 2011, 141 consecutive patients underwent cardiac surgery requiring cardiopulmonary bypass at our hospital. We measured ACT 3 minutes after the initial administration of heparin and considered ACT values >400 seconds as appropriate for safe initiation of CPB. Results: Using the proposed formula, administered heparin dose was 241 ± 27 IU/kg and target ACT was achieved in 86.4% of patients. Multivariate analysis was performed to determine the effect of patient background factors on target ACT achievement. Body weight, age, and preoperative heparin therapy, which showed significant differences, were further analyzed. Conclusions: This study demonstrated that our newly developed formula could be used to properly calculate the optimal initial dose of heparin.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Evaluation of a New Formula for Calculating Heparin Dose for Cardiopulmonary Bypass Patients

Nakasuji¹,

Matsushita²,

Inaba³

et al. 2014

OJTS

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“…In another study in which heparin doses were administered at 300 IU/kg and 145 IU/kg without calculating the body weight, a lower rate of blood transfusions was required and less postoperative drainage volumes were found in the low-dose heparin group. [11] Although the positive results of heparin reduction were demonstrated in these studies, it is not true that the individual doses of the patients should be administered without taking the standard dose. In a study examining heparin pharmacokinetics during CPB, it was shown that there were wide individual differences in plasma heparin levels, and peripheral compartment distribution contributed to these differences and was responsible for heparin rebound.…”

Section: Discussionmentioning

confidence: 92%

Heparin dose calculated according to lean body weight during on-pump heart surgery

Aykut

Sabuncu

Demir

et al. 2018

Turk Gogus Kalp Dama

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Bu çalışmada geleneksel heparin rejimi ile yağsız vücut ağırlığına göre hesaplanan heparin doz rejimi yeterli antikoagülasyonun sağlanması ve perioperatif kanama ile ilişkili komplikasyonlar açısından karşılaştırıldı. Ça lış ma pla nı: Bu prospektif, tek kör, randomize çalışmaya Haziran 2016-Ocak 2017 tarihleri arasında kardiyopulmoner baypas ile elektif kapak ameliyatı yapılan toplam 100 erişkin hasta (42 erkek, 58 kadın; ort. yaş 52.7 yıl; dağılım, 22-84 yıl) alındı. Kardiyopulmoner baypas öncesinde heparin dozu, aktüel vücut ağırlığına göre (n=50) ve yağsız vücut ağırlığına göre (n=50) olmak üzere 4 mg/kg olarak ayarlandı. Kardiyopulmoner baypasa başlanması için minimum aktive pıhtılaşma zamanı hedef değeri 480 sn. olarak kabul edildi. Demografik ve hemodinamik veriler, heparin sonrası aktive pıhtılaşma zamanı, ek heparin ve perioperatif transfüzyon, ameliyat sonrası drenaj miktarları, yeniden ameliyatlar ve mortalite kaydedildi. Bul gu lar: Demografik veriler, kros klemp ve kardiyopulmoner baypas süreleri ve ameliyat sırası transfüzyon ihtiyacı gruplar arasında anlamlı düzeyde farklı değildi. Heparinin başlangıç ve toplam dozlarının yanı sıra toplam protamin dozu, aktüel vücut ağırlığı grubunda anlamlı düzeyde daha yüksekti. Ameliyat sonrası transfüzyon oranları da, bu grupta daha yüksekti. Yağsız vücut ağırlığı grubunda hiçbir hastada yeniden ameliyat gerekli olmaz iken, aktüel vücut ağırlığı grubunda üç hasta yeniden ameliyat edildi. So nuç: Çalışma sonuçlarımız kardiyopulmoner baypas sırasında yağsız vücut ağırlığına göre hesaplanan heparin doz titrasyonu ile yeterli antikoagülasyon sağlanabileceğini ve toplam heparin ve protamin dozlarının düşürülmesi ile ameliyat sonrası kanama ve kan ürünü transfüzyonu gereksinimin azaltılabileceğini göstermiştir. Anah tarsöz cük ler: Aktüel vücut ağırlığı; kan yönetimi; kardiyak anestezi; kalp cerrahisi; kardiyopulmoner baypas; heparin; yağsız vücut ağırlığı; protamin; tamponad.

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“…Studies have screened for genes associated with the levels of chemokines and cytokine following OPCAB surgery, but little attention has been paid to the corresponding miRNA transcripts ( 8 ). In addition, the molecular mechanisms of complications, including hemostasis and coagulation disorders, caused by OPCAB grafting are unclear ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Expression profile analysis based on DNA microarray for patients undergoing off-pump coronary artery bypass surgery

Sun

Gao

Sun

et al. 2016

Experimental and Therapeutic Medicine

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Off-pump coronary artery bypass (OPCAB) surgery is the most effective treatment for coronary heart disease. The aim of this study was to explore the effects of OPCAB on the basis of the associated molecular mechanisms. GSE12486 expression profiles downloaded from the Gene Expression Omnibus database (GEO) were analyzed to identify the differentially expressed genes (DEGs). Principal component analysis (PCA) was conducted based on the expression profiles of DEGs. Function and pathway enrichment of upregulated DEGs was performed, followed by protein-protein interaction (PPI) network construction. Gene Set Enrichment Analysis (GSEA) was used for miRNA enrichment analysis based on expression profiles and prediction of their association with the disease. Cytoscape was applied to construct miRNA regulatory networks of DEGs. In total 64 DEGs were identified, including 63 upregulated and 1 downregulated gene. The first principal component in the PCA analysis was able to distinguish between pre- and post-OPCAB samples. Upregulated DEGs mainly enriched 20 Gene Ontology terms, such as chemokine activity, and 5 pathways including the chemokine signaling pathway. The constructed PPI network contained 234 edges and 55 nodes, and 10 upregulated hub nodes, including FBJ murine osteosarcoma viral oncogene homolog (FOS), were screened. A total of 36 miRNAs, including MIR-224 and MIR-7, were screened by GSEA enrichment analysis. A miRNA regulatory network including 176 edges and 97 nodes was constructed, showing the regulatory relationships between miRNAs and DEGs. For example, early growth response 2 (EGR2) was regulated by 8 miRNAs including MIR-150, MIR-142-3P, MIR-367 and MIR-224. The identified DEGs might play important roles in patients pre- and post-OPCAB surgery via the regulation of associated genes.

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A comparison of low vs conventional‐dose heparin for minimal cardiopulmonary bypass in coronary artery bypass grafting surgery

Cited by 22 publications

References 19 publications

Evaluation of a New Formula for Calculating Heparin Dose for Cardiopulmonary Bypass Patients

Evaluation of a New Formula for Calculating Heparin Dose for Cardiopulmonary Bypass Patients

Heparin dose calculated according to lean body weight during on-pump heart surgery

Expression profile analysis based on DNA microarray for patients undergoing off-pump coronary artery bypass surgery

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