Heparinized cardiopulmonary bypass circuits and low systemic anticoagulation: An analysis of nearly 6000 patients undergoing coronary artery bypass grafting

Abstract

The experience with this patient cohort including mostly low- to medium-risk patients with a relatively short cardiopulmonary bypass time indicates that coronary artery bypass grafting performed with heparin-coated circuits and reduced level of systemic heparinization is safe and results in a very satisfactory clinical course. No signs of clotting or other technical incidents were recorded.

Veno-venous extracorporeal membrane oxygenation support during lung volume reduction surgery for a severe respiratory failure patient with emphysema

“…We decided not to use CPB as it usually requires full heparinisation and anticoagulation, which may have worsened bleeding and altered surgical operating conditions (7). Given its size and complexity, a CPB circuit would also not have permitted ongoing postoperative support.…”

MECC Equipment

“…Recent data emerged from a large cohort study by Ovrum et al indicate that the routine use of heparin-coated CPB circuits combined with reduced systemic heparinization is safe and has encouraging clinical results, with low rates of morbidity and mortality, as in OPCAB surgery. They reported few postoperative complications, limited need for banked blood transfusions and short periods of postoperative ventilatory support [ 46 ] . However, other studies showed controversial results, indicating no bene fi t when using heparin-coated circuits [ 47 ] .…”

Left Ventricular Thrombus During Cardiopulmonary Bypass as the Primary Manifestation of Heparin-Induced Thrombocytopenia

“…For normothermic CPB, a heparin-coated, minimal extracorporeal circulation (MECC) with a recommended activated coagulation time (ACT) target of 250 to 300 seconds was used. 8,9 CPB was instituted after the administration of 175 IU/kg of unfractionated heparin (UFH), which resulted in an ACT of 309 seconds. According to the authors' institutional protocol, tranexamic acid was administered as a bolus of 10 mg/kg, followed by a continuous infusion of 1 mg/kg/h during CPB (CPB duration ϭ 198 minutes, aortic cross-clamp time ϭ 146 minutes).…”

“…Additionally, the miniaturized, heparin-bonded circuit of the MECC minimizes the contact of blood to artificial surfaces and air, resulting in fewer inflammatory and hemostatic abnormalities. 8,9,20 Although preoperative therapy with heparin is a well-known risk factor for acquired antithrombin deficiency, 21 the normal antithrombin activity measured on the day of surgery strongly argued against this hypothesis. Thus, HIT appeared the most plausible cause for the new occurrence of an LV thrombus despite its unusual manifestation in a patient with uneventful preoperative thromboprophylaxis with LMWH.…”

“…Additionally, the preoperative combination of aspirin and LMWH complied with current practice guidelines for patients with aortic valve stenosis, and the intraoperative ACT complied with the recommended target for MECC procedures. 8,9,28 Although no serial platelet counts or HIT assays were obtained preoperatively, platelets had increased on the day of surgery in relation to the initial measurement taken 2 weeks earlier when LMWH had been started. Finally, the combination of a thrombotic event during heparin-anticoagulated CPB with a positive HIPA and a subsequent platelet decline in a patient without major hypercoagulopathic risk factors strongly suggests new-onset HIT as the most probable cause for intracardiac clotting.…”