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The Annals of Thoracic Surgery, Vol 58, 734-740, Copyright © 1994 by The Society of Thoracic Surgeons
WR Wagner, PC Johnson, KA Thompson and GC Marrone
This prospective, randomized study involving patients undergoing isolated
coronary artery bypass grafting investigated whether the use of
heparin-coated bypass circuits with an uncoated cardiotomy reservoir (n =
10) compared with standard uncoated bypass circuits (n = 10) resulted in
differences in patient outcome and hemostatic alterations. There were no
differences in postoperative blood loss, transfusion requirements, and
routine coagulation test results between groups. Immunoassays for platelet
alpha-granule constituents platelet factor 4 and beta-thromboglobulin,
thrombin generation by-product F1.2, fibrinopeptide A,
thrombin-antithrombin complex, and fibrinolysis by- product D-dimer also
demonstrated no significant differences between groups, although trends for
lower platelet secretion with heparin coating were noted. Increases were
found in beta-thromboglobulin and platelet factor 4 concentrations at 10 (p
< 0.03) and 30 minutes (p < 0.001) of CPB, respectively, and
continuing throughout CPB (p < 0.001) for both groups versus values
measured before incision. No significant differences were seen between
levels 5 minutes prior to aortic cross- clamp release and those obtained 8
and 45 minutes after cross-clamp release. Conversely, no significant
increases in F1.2, thrombin- antithrombin complex, and D-dimer were seen
prior to release of the aortic cross-clamp, but afterward increases
occurred that were highly significant (p < 0.001). The temporal data
suggest that platelet activation occurs primarily as a result of contact
with the cardiopulmonary bypass circuitry, whereas thrombin generation and
fibrinolytic activity are not significant until reperfusion of the heart
and lungs.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Heparin-coated cardiopulmonary bypass circuits: hemostatic alterations and postoperative blood loss
Department of Surgery, University of Pittsburgh, Pennsylvania.
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