Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: A joint vascular research group study

Abstract

Heparin does not increase blood loss or the need for blood transfusion during surgery. Heparin is not necessary to prevent distal thrombosis when the aorta is cross clamped. The results of the study are consistent with the known mechanisms leading to intraoperative MI and strategies for its prevention. Intravenous heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in relation to AAA surgery.

Abrupt formation and spontaneous resolution of a right atrial thrombus detected by intraoperative transesophageal echocardiography during replacement of an abdominal aortic aneurysm

“…The possibility of increased bleeding with heparin and, perhaps more importantly, worries about toxicity and the direct anticoagulant effects of protamine sulfate, have led many surgeons to avoid heparin altogether [4]. Additionally, heparin is not necessary to prevent distal thrombosis during aorta cross clamping [5]. However, Thompson and colleagues [5] reported that heparin did not increase blood loss or the need for blood transfusion during replacement of an AAA and was an important prophylactic agent against peri-operative myocardial infarction in relation to replacement of an AAA.…”

“…Additionally, heparin is not necessary to prevent distal thrombosis during aorta cross clamping [5]. However, Thompson and colleagues [5] reported that heparin did not increase blood loss or the need for blood transfusion during replacement of an AAA and was an important prophylactic agent against peri-operative myocardial infarction in relation to replacement of an AAA. The patient had a medical history of axillo-femoral bypass, PTCA, and CABG.…”

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

“…Aforementioned transformation includes: the inflammation and neovascularization [25], proteolytic activity [26] -especially increase in elastase production [27], decrease in collagen synthesis [28][29][30] and production of abnormal collagen [29]. From the clinical point of view, rapid growth and volume of ILT is correlated with the high risk of rupture [31].…”

Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association

“…The safety of intraoperative heparin administration during vascular surgical procedures has been demonstrated in large studies (109). Heparin is usually given intravenously and during open AAA repair is typically administered 2-3 minutes before cross-clamping the aorta.…”