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Heparin kinetics in vascular surgery
N N Williams1, P J Broe, P Burke
1Department of Surgery, Royal College of Surgeons, Beaumont Hospital, Dublin, Ireland.
European Journal of Vascular Surgery
|December 1, 1989
Summary
This study found that surgical trauma does not significantly alter heparin sensitivity in vascular surgery patients. Excessive heparin doses may be commonly used, as plasma heparin levels were not reliable indicators of anticoagulant effect.
Area of Science:
- Vascular Surgery
- Pharmacokinetics
- Anesthesiology
Background:
- Limited data exists on heparin efficacy and kinetics during vascular surgery.
- Surgical trauma's impact on heparin's effects is not well understood.
Purpose of the Study:
- To evaluate heparin kinetics during major vascular surgery.
- To assess the influence of surgical trauma on heparin's anticoagulant effects.
Main Methods:
- Nine patients undergoing major vascular surgery were studied.
- Activated partial thromboplastin time (APTT) and plasma heparin levels were measured pre- and intra-operatively.
- Heparin was administered intravenously at 100 u/kg body weight.
Main Results:
- Mean APTT levels increased significantly, remaining over 2.5 times control at 2 hours post-administration.
- Plasma heparin levels were similar across patients, but APTT results varied significantly.
- Plasma heparin concentration was not a reliable indicator of anticoagulant effect.
Conclusions:
- Surgical trauma does not appear to significantly alter patient sensitivity to heparin.
- Current heparin dosing in vascular surgery may be excessive.
- APTT is a more reliable measure of heparin's anticoagulant effect than plasma heparin levels.