Journal article

Publication year: 1995

Pages: 954-960

Journal: Anaesthesia: Peri-operative medicine, critical care and pain

Volume number: 50

Issue number: 11

ISSN: 0003-2409

eISSN: 1365-2044

DOI Link: https://doi.org/10.1111/j.1365-2044.1995.tb05927.x

Publisher: Wiley

Abstract: 
Heparin is still the most commonly used anticoagulant cardiac surgery necessitating cardiopulmonary bypass. In recent years, endothelial-related coagulation (e.g. thrombomodulin/protein C-system) has enlarged our knowledge of the regulation of haemostasis. In a controlled randomised study, the influence of different regimens of anticoagulation on the thrombomodulin/protein C-system was studied. Sixty patients undergoing elective coronary artery bypass grafting were randomly allocated into four groups (n = 15) to receive: 300 IU.kg(-1) of heparin before bypass; 600 IU.kg(-1) of heparin; 300 IU.kg(-1) of heparin as bolus followed by a continous infusion of 10 000 IU.h(-1) until the end of bypass; or 600 IU.kg(-1) of heparin plus 'high dose' aprotinin (2 million IU of aprotinin before bypass, 500 000 IU.h(-1) until the end of the operation and 2 million IU added to the bypass pump prime). Grouping was blinded for the surgeon and the anaesthetist. Plasma concentrations of thrombomodulin, protein C and (free) protein S as well as thrombin/antithrombin III were measured by enzyme-linked immunosorbent assays after induction of anaesthesia, during and after bypass, at the end of surgery, 5 h after bypass, and on the first postoperative day. Activated clotting time was significantly longer during bypass in group 2 (566 (60)s) and group 4 (655 (59)s, whereas standard coagulation parameters showed no differences between the four groups. Blood loss and use of homologous blood and blood products were highest in groups 2 and 3. Thrombomodulin plasma levels were similar (and normal) at baseline (<40 ng.l(-1)), decreased during bypass and reached baseline values postoperatively without showing significant group differences. Protein C did not show any differences among the groups within the investigation period. 'Free' protein S plasma levels were most reduced in group 1 (from 68 (8%) to 48 (9%) after bypass. Thrombin/antithrombin III plasma concentrations increased most in groups 1 (to 69 (14) mu g.l(-1) after bypass) and 2 (to 48 (7) mu g.l(-1) after bypass), whereas they remained significantly lower in groups 3 and 4. The thrombomodulin/protein C-system was not significantly influenced by the regimen of anticoagulation. Administration of 'high dose' heparin was associated with the highest blood loss, which could not be related to endothelial-associated coagulation.

Harvard Citation style: BOLDT, J., SCHINDLER, E., WELTERS, I., WITTSTOCK, M., STERTMANN, W. and HEMPELMANN, G. (1995) THE EFFECT OF THE ANTICOAGULATION REGIMEN ON ENDOTHELIAL-RELATED COAGULATION IN CARDIAC-SURGERY PATIENTS (Retracted article. See vol. 70, pg. 1104, 2015), Anaesthesia: Peri-operative medicine, critical care and pain, 50(11), pp. 954-960. https://doi.org/10.1111/j.1365-2044.1995.tb05927.x

APA Citation style: BOLDT, J., SCHINDLER, E., WELTERS, I., WITTSTOCK, M., STERTMANN, W., & HEMPELMANN, G. (1995). THE EFFECT OF THE ANTICOAGULATION REGIMEN ON ENDOTHELIAL-RELATED COAGULATION IN CARDIAC-SURGERY PATIENTS (Retracted article. See vol. 70, pg. 1104, 2015). Anaesthesia: Peri-operative medicine, critical care and pain. 50(11), 954-960. https://doi.org/10.1111/j.1365-2044.1995.tb05927.x