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Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications
Duk-hee Chun1, Seong-wan Baik, So Yeon Kim
1Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Sungnam, Korea.
Insights
Reduced heparin responsiveness (HR(reduced)) did not increase myocardial infarction (MI) risk after off-pump coronary artery bypass graft surgery (OPCAB). Low albumin and high platelets predicted HR(reduced), but outcomes remained favorable due to strict ACT protocols.
Area of Science:
- Cardiology
- Anesthesiology
- Vascular Surgery
Background:
- Heparin responsiveness is crucial for anticoagulation during cardiac surgery.
- Reduced heparin responsiveness (HR(reduced)) may impact perioperative outcomes.
- Off-pump coronary artery bypass graft surgery (OPCAB) requires careful anticoagulation management.
Purpose of the Study:
- To assess the clinical significance of HR(reduced) on myocardial infarction (MI) incidence post-OPCAB.
- To identify predictors associated with HR(reduced) in OPCAB patients.
Main Methods:
- Prospective enrollment of 199 patients undergoing elective OPCAB.
- Heparin administration (150 U/kg) to achieve activated clotting time (ACT) ≥ 300 s.
- Calculation of heparin sensitivity index (HSI); HR(reduced) defined as HSI < 1.0.
Main Results:
- No significant correlation found between HSI and postoperative cardiac enzyme levels.
- The incidence of MI was not elevated in patients with HR(reduced).
- HR(reduced) was more prevalent in patients with lower plasma albumin and higher platelet counts.
Conclusions:
- HR(reduced) was not linked to adverse ischemic outcomes in the perioperative period for OPCAB patients.
- A rigorous protocol targeting ACT, irrespective of HR(reduced), likely contributed to favorable outcomes.
Aim:
To evaluate the clinical impact of reduced heparin responsiveness (HR(reduced)) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB), and to identify the predictors of HR(reduced).
Methods:
A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis, 150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥ 300 s, and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HR(reduced)). The relationships between the HSI and postoperative MI, cardiac enzyme levels and preoperative risk factors of HR(reduced) were investigated.
Results:
There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HR(reduced) patients. HR(reduced) occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.
Conclusion:
HR(reduced) was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients, which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HR(reduced).
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