Preoperative Low-Molecular-Weight Heparin Prophylaxis Associated with Increased Heparin Resistance Frequency in On-Pump Coronary Artery Bypass Graft Surgery

Abstract

Background. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are being used for preoperative management of critical coronary artery disease. However, preoperative UFH therapy may cause a reduction in antithrombin concentrations, leading to various degrees of heparin resistance (HR). The main purpose of this study is to investigate the effects of preoperative LMWH on HR during cardiopulmonary bypass (CPB). Methods. Data were retrospectively reviewed from adult patients that underwent on-pump coronary artery bypass graft (CABG) surgery. Four hundred fifty-seven patients underwent CABG, and 139 of them, who had isolated on-pump CABG, were included in the study. The heparin sensitivity index was calculated if activated clotting time levels were discovered below 400 seconds. Values less than 1.3 were accepted as HR. Results. Of 139 patients who underwent on-pump CABG, preoperative LMWH was administered in 59 patients (56.8%). Intraoperative HR occurred in 29 patients (20.9%). Patients who received preoperative LMWH had an increased risk of developing HR compared with patients who did not receive LMWH (odds ratio 4.8 and 95% confidence interval 1.7–13.5). CPB duration and aortic clamp duration were significantly longer in patients who developed intraoperative HR when compared to those in patients who did not develop HR. Conclusion. Preoperative treatment with LMWH may cause intraoperative HR. Corrective and preventive arrangements with close follow-up should be performed in this group of patients.

Protamine dosing and its impact in cardiac surgery transfusion practice—A retrospective bi‐institutional analysis

“…The BMI was lower and there was a greater percentage of patients receiving preoperative anticoagulant in the high ratio group. This may have led to a higher dose of required protamine and higher baseline ACTs in the high‐ratio group support this presumption of acquired AT deficiency, which requires a higher heparin dose or other treatment, including AT replacement, and impacts protamine dose 13 . Our retrospective study was limited as AT levels were not measured and heparin resistance was not diagnosed.…”

“…This may have led to a higher dose of required protamine and higher baseline ACTs in the high-ratio group support this presumption of acquired AT deficiency, which requires a higher heparin dose or other treatment, including AT replacement, and impacts protamine dose. 13 Our retrospective study was limited as AT levels were not measured and heparin resistance was not diagnosed. However, a similar trend was reflected in higher baseline ACT in the high-ratio group (143.4 vs. 127.3 s; p < .001).…”

Inflammatory Biomarkers and Blood Physical Property Transformations Following On-Pump Coronary Artery Bypass Graft Surgery

“…For example, the use of anti-inflammatory drugs such as corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) [30][31][32][33], pentoxifylline (Trental), or Ginkgo biloba [34] could be explored post surgery to mitigate the hypercoagulable state often observed in CABG patients. Additionally, anticoagulant therapies like low molecular weight heparin could be considered in conjunction with anti-inflammatory treatments to provide a multi-faceted approach to reducing postoperative complications [35]. Thus, this study raises the possibility of personalized medicine approaches, where treatments could be tailored based on an individual patient's inflammatory markers and blood rheological properties.…”