Off-pump coronary artery bypass grafting using continuous heparin infusion

Sangwan, Dinesh Kumar; Shroff, Pravin K.; Deval, Mandar; Saha, Kamales Kumar; Jacob, Rinu; Adsul, Ratnaprobha; Jagdale, Lukash

doi:10.1016/j.ihj.2016.04.024

Cited by 6 publications

(9 citation statements)

References 14 publications

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“…There are also reports in the literature describing cases of thrombosis following low-dose heparin administration. [16] In our study, intra-and postoperative thrombosis was not observed in both groups of patients. Conversely, in the ABW group, three patients were re-operated due to bleeding.…”

Section: Discussioncontrasting

confidence: 42%

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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Section: Discussioncontrasting

confidence: 42%

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

Aykut

Sabuncu

Demir

et al. 2018

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

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“…25 Saha et al observed similar ischemic related complications between the low and high heparinization levels during off-pump cardiac surgery. Accordingly, the investigators opted to target an ACT value above 200 s 26 Similarly, Song et al recommended a lower level of anticoagulation in patients on dual antiplatelets who underwent OPCAB which resulted in lower hemorrhagic complications and similar unfavorable ischemic events. 27 Bull et al found that OP-CABG provided a good graft patency, and the length of stay did not differ from the conventional on-pump surgery.…”

Section: Discussionmentioning

confidence: 99%

Optimum heparin dose in off-pump coronary artery bypass grafting: A systematic review and meta-analysis

et al. 2023

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Introduction Off-pump coronary artery bypass grafting (OPCABG) was introduced many years ago aiming to reduce the known complications of conventional on-pump coronary surgeries. Heparin is required during the procedures, but the available protocols have diverse dosage regimens. The primary objective of this systematic review is to examine the effect of different heparin doses on the outcomes of OPCABG. Evidence acquisition MEDLINE and EMBASE were searched. Four reviewers identified eligible clinical trials. Two reviewers extracted data and independently assessed the risk of bias using Cochrane tool. The primary outcome was the activated clotting time (ACT) at three minutes. The secondary outcomes were proportion of patients requiring blood products and the length of hospital stay. An aggregate data approach was used. Evidence synthesis Three single-center randomized studies recruiting 256 patients were included. The studies compared low-dose (1.5–2 mg/kg) and high-dose (3 mg/kg) heparin boluses. The overall mean difference for ACT after three minutes between low- and high-dose heparin is – 126.16 (95% CI: - 142.19, - 110.14). The proportion of patients requiring blood products after surgery [odd ratio 1.27 (95% CI: 0.69, 2.32)] or the overall length of stay [mean difference −0.15 (95% CI: −0.84, 0.53)] did not differ between the heparin doses. Conclusions In OPCABG, high-dose compared with low-dose heparin did not affect the utilization of more blood products or increased the overall length of stay. Unsurprisingly, ACT values were higher in the high-dose heparin group. Larger and adequately powered randomized clinical trials are indicated to resolve the uncertainty.

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“…[ 14 ] There are other reports citing instances of thrombosis following smaller doses of heparin used for systemic heparinization. [ 15 ] An apprehension on the minds of the clinicians is, whether performing OPAB surgery leads to worse outcomes due to the hyper coagulant state that is associated with OPCAB; such clinicians achieve systemic heparinization with higher dose of heparin, up to 5 mg/kg. [ 12 16 ] We studied the amount of additional protamine required to achieve the baseline ACT ±, blood loss (intraoperative and postoperative), myocardial ischemic episodes requiring inotropic agents and intra-aortic balloon counterpulsation, perioperative myocardial infarction assessed by electrocardiographic and enzyme criteria.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two doses of heparin on outcome in off-pump coronary artery bypass surgery patients: A prospective randomized control study

et al. 2017

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Introduction:While off pump coronary artery bypass surgery is practiced with an intention to reduce the morbidity associated with cardiopulmonary bypass, the resultant ‘hypercoagulability’ needs to be addressed. Complications such as cavitary thrombus possibly due to the hyper coagulability after off pump coronary artery bypass surgery have been described. Many clinicians use higher doses of heparin - up to 5 mg/kg in order to thwart this fear. Overall, there appears to be no consensus on the dose of heparin in off pump coronary artery bypass surgeries.Aim of the Study:The aim of the study was understand the differences in outcome of such as transfusion requirement, myocardial ischemia, and morbidity when two different doses were used for systemic heparinization.Methods:Elective patients scheduled for off pump coronary artery bypass surgery were included. Ongoing anti platelet medication was not an exclusion criteria, however, anti platelet medications were ceased about a week prior to surgery when possible. Thoracic epidural anesthesia was administered as an adjunct in patients who qualified for it. By computer generated randomization chart, patients were chosen to receive either 2 or 3 mg/kg of intravenous unfractioned heparin to achieve systemic heparinization with activated clotting time targeted at >240 secs. Intraoperative blood loss, postoperative blood loss, myocardial ischemic episodes, requirement of intraaortic balloon counter pulsation and transfusion requirement were analyzed.Results:Sixty two patients participated in the study. There was one conversion to cardiopulmonary bypass. The groups had comparable ACT at baseline (138.8 vs. 146.64 seconds, P = 0.12); 3 mg/kg group had significantly higher values after heparin, as expected. But after reversal with protamine, ACT and need for additional protamine was similar among the groups. Intraoperative (685.56 ± 241.42 ml vs. 675.15 ± 251.86 ml, P = 0.82) and postoperative blood loss (1906.29 ± 611.87 ml vs 1793.65 ± 663.54 ml, p value 0.49) were similar among the groups [Table 4]. The incidence of ECG changes of ischemia, arrhythmias, conversion to CPB, or need for intra-aortic balloon counter pulsation were not different.Conclusions:Use of either 2 or 3 mg/kg heparin for systemic heparinization in patients undergoing OPCAB did not affect the outcome.

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Off-pump coronary artery bypass grafting using continuous heparin infusion

Cited by 6 publications

References 14 publications

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

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

Optimum heparin dose in off-pump coronary artery bypass grafting: A systematic review and meta-analysis

Comparison of two doses of heparin on outcome in off-pump coronary artery bypass surgery patients: A prospective randomized control study

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