More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT

George J. Despotis, J. Heinrich Joist, Charles W. Hogue, Alexander Alsoufiev, D. Joiner-Maier, Samuel A. Santoro, Edward Spitznagel, Jeffrey I. Weitz, Lawrence T. Goodnough

Research output: Contribution to journalArticle

Abstract

This study was designed to determine whether the maintenance of higher than usual patient-specific heparin concentrations during cardiopulmonary bypass (CPB) was associated with more effective suppression of hemostasis system activation. Thirty-one patients scheduled for repeat cardiac sugery or combined procedures (i.e., coronary revascularization + valve repair/replacement) were consented and enrolled in this study. All patients received porcine heparin and protamine and were randomly assigned to monitoring of anticoagulation by either celite ACT alone (Control, n = 16) or by kaolin ACT combined with on-site measurements of whole blood heparin concentration (Intervention, n = 15). Blood specimens collected before administration of heparin, before weaning from CPB and after administration of protamine were analyzed with a battery of coagulation assays. Patients in the intervention cohort received appreciably greater heparin doses than control patients, resulting in higher anti-Xa heparin levels at the end of CPB. Fibrinopeptide A and D-dimer levels were higher in the control group before discontinuation of CPB. Percent decrease during CPB were greater in the control group for factors V and VIII, fibrinogen and antithrombin III. Percent decrease in complement 3 was greater in the control group after protamine and bleeding times measured in the Intensive Care Unit were significantly more prolonged in this group. Maintenance of higher patient-specific heparin concentrations during CPB more effectively suppresses excessive hemostatic system activation than do standard heparin doses chosen based on measurement of ACT. These findings may explain, at least in part, the significant reduction in perioperative blood loss and blood product use when higher heparin concentrations are maintained.

Original languageEnglish (US)
Pages (from-to)902-908
Number of pages7
JournalThrombosis and Haemostasis
Volume76
Issue number6
StatePublished - Dec 1996
Externally publishedYes

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Hemostatics
Thoracic Surgery
Heparin
Cardiopulmonary Bypass
Protamines
Control Groups
Fibrinopeptide A
Diatomaceous Earth
Kaolin
Complement C3
Bleeding Time
Factor V
Antithrombin III
Factor VIII
Weaning
Hemostasis
Fibrinogen
Intensive Care Units
Swine

ASJC Scopus subject areas

  • Hematology

Cite this

Despotis, G. J., Heinrich Joist, J., Hogue, C. W., Alsoufiev, A., Joiner-Maier, D., Santoro, S. A., ... Goodnough, L. T. (1996). More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT. Thrombosis and Haemostasis, 76(6), 902-908.

More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT. / Despotis, George J.; Heinrich Joist, J.; Hogue, Charles W.; Alsoufiev, Alexander; Joiner-Maier, D.; Santoro, Samuel A.; Spitznagel, Edward; Weitz, Jeffrey I.; Goodnough, Lawrence T.

In: Thrombosis and Haemostasis, Vol. 76, No. 6, 12.1996, p. 902-908.

Research output: Contribution to journalArticle

Despotis, GJ, Heinrich Joist, J, Hogue, CW, Alsoufiev, A, Joiner-Maier, D, Santoro, SA, Spitznagel, E, Weitz, JI & Goodnough, LT 1996, 'More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT', Thrombosis and Haemostasis, vol. 76, no. 6, pp. 902-908.
Despotis, George J. ; Heinrich Joist, J. ; Hogue, Charles W. ; Alsoufiev, Alexander ; Joiner-Maier, D. ; Santoro, Samuel A. ; Spitznagel, Edward ; Weitz, Jeffrey I. ; Goodnough, Lawrence T. / More effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT. In: Thrombosis and Haemostasis. 1996 ; Vol. 76, No. 6. pp. 902-908.
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