Heparin-coated cardiopulmonary bypass circuits: Hemostatic alterations and postoperative blood loss

Wagner, William R.; Johnson, Peter C.; Thompson, Kathleen; Marrone, Gary C.

doi:10.1016/0003-4975(94)90736-6

Cited by 64 publications

(21 citation statements)

References 17 publications

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“…Despite these improvements, however, we and also other investigators reported no reduction in thrombin generation in patients undergoing CPB with the use of a heparin-coated extracorporeal circuit [14-17], whereas others have found evidence of some possible benefit of these surfaces on the coagulation cascade [18]. …”

Section: Introductionmentioning

confidence: 64%

Thrombin generation during cardiopulmonary bypass: the possible role of retransfusion of blood aspirated from the surgical field

Weerwind¹,

Lindhout

Caberg

et al. 2003

Thrombosis J

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BackgroundIn spite of using heparin-coated extracorporeal circuits, cardiopulmonary bypass (CPB) is still associated with an extensive thrombin generation, which is only partially suppressed by the use of high dosages of heparin. Recent studies have focused on the origins of this thrombotic stimulus and the possible role of retransfused suctioned blood from the thoracic cavities on the activation of the extrinsic coagulation pathway. The present study was designed to find during CPB an association between retransfusion of suctioned blood from the pericardium and pleural space, containing activated factor VIIa and systemic thrombin generation.MethodsBlood samples taken from 12 consenting patients who had elective cardiac surgery were assayed for plasma factor VIIa, prothrombin fragment 1+2 (F1+2), and thrombin-antithrombin (TAT) concentrations. Blood aspirated from the pericardium and pleural space was collected separately, assayed for F1+2, TAT, and factor VIIa and retransfused to the patient after the aorta occlusion.ResultsAfter systemic heparinization and during CPB thrombin generation was minimal, as indicated by the lower than base line plasma levels of F1+2, and TAT after correction for hemodilution. In contrast, blood aspirated from the thoracic cavities had significantly higher levels of factor VIIa, F1+2, and TAT compared to the simultaneous samples from the blood circulation (P < 0.05). Furthermore, after retransfusion of the suctioned blood (range, 200–1600 mL) circulating levels of F1+2, and TAT rose significantly from 1.6 to 2.9 nmol/L (P = 0.002) and from 5.1 to 37.5 μg/L (P = 0.01), respectively. The increase in both F1+2, and TAT levels correlated significantly with the amount of retransfused suctioned blood (r = 0.68, P = 0.021 and r = 0.90, P = 0.001, respectively). However, the circulating factor VIIa levels did not correlate with TAT and F1+2 levels.ConclusionsThese data suggest that blood aspirated from the thoracic cavities during CPB is highly thrombogenic. Retransfusion of this blood may, therefore, promote further systemic thrombin generation during CPB.

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Section: Introductionmentioning

confidence: 64%

Thrombin generation during cardiopulmonary bypass: the possible role of retransfusion of blood aspirated from the surgical field

Weerwind¹,

Lindhout

Caberg

et al. 2003

Thrombosis J

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“…Although blood-surface interface modifications for the CPB circuit have also been shown to decrease markers of inflammation, translation into clinical benefit in terms of reduced morbidity, mortality, or resource utilization has been equivocal. The concern over thrombotic complications tempered enthusiasm among cardiac surgeons (291,(309)(310)(311)(312)(313). Surface modification such as heparin-bonded circuitry for extracorporeal circulation holds promise for reduction of the systemic inflammatory response to CPB, but at present the evidence is sufficiently conflicting that firm recommendations are not at hand.…”

Section: Attenuation Of the Systemic Sequelae Of Cpbmentioning

confidence: 99%

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

Wilkins¹

2004

Journal of the American College of Cardiology

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“…[17][18]23,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] However, all of these studies, with the exception of one, 17 do not present information comparing the costs resulting from clinical outcomes of using heparin-bonded versus nonbonded circuits. There are currently no published clinical outcome and cost comparisons of covalently bonded circuits (Carmeda) and ionically bonded circuits (Duraflo II).…”

Section: Outcomes and Costsmentioning

confidence: 99%

“…Examination of 91 research studies on heparinbonded circuits reveals that only 16 of them 17,22,24,34,[36][37][38][39][40]43,[48][49][50][51][52] provide data on clinical outcomes from which outcomes can directly be calculated to compare costs. Three of these studies 36,42,51 cannot be integrated with the others because they examined only redo patients or patients with acute respiratory distress syndrome.…”

Section: Article Identification and Inclusion Criteriamentioning

confidence: 99%

Heparin-bonded circuits: clinical outcomes and costs

Mahoney

1998

Perfusion

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The aim of this study was to use meta-analysis to combine the results of numerous studies and examine the impact of heparin-bonded circuits on clinical outcomes and the resulting costs. Heparin-bonded circuits, both ionically and covalently bonded, are examined separately.The results of the study provide evidence that heparin-bonded circuits result in improved clinical outcomes when compared to the identical nonheparin-bonded circuits. These improved clinical outcomes result in subsequent lower costs per patient with their use. However, differences are apparent in the significance and magnitude of these outcomes between ionically and covalently bonded circuits. Covalently bonded circuits provide a greater magnitude and significance of improvement in clinical outcomes than ionically bonded circuits. Total cost savings can be expected to be three times greater with covalently bonded circuits ($3231 versus $1068).It was concluded that the choice regarding the use of a heparin-bonded circuits and the type of heparin-bonded circuit used has the potential to alter clinical outcomes and subsequent costs. Cost consideration cannot be ignored, but clinical benefits should be the main rationale for the choice of cardiopulmonary bypass circuit. This analysis provides evidence that clinical benefits and cost savings can both be derived from use of the same technology -covalently bonded circuits.

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Heparin-coated cardiopulmonary bypass circuits: Hemostatic alterations and postoperative blood loss

Cited by 64 publications

References 17 publications

Thrombin generation during cardiopulmonary bypass: the possible role of retransfusion of blood aspirated from the surgical field

Thrombin generation during cardiopulmonary bypass: the possible role of retransfusion of blood aspirated from the surgical field

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

Heparin-bonded circuits: clinical outcomes and costs

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