Are all heparins safe for on-pump heart surgery?

Area of Science:

• Cardiovascular Surgery
• Pharmacology
• Anesthesiology

Background:

• Panpharma heparin (®) was used in on-pump cardiac surgery, replacing Choay heparin (®).
• Unusual postoperative bleeding events prompted an investigation into heparin efficacy.

Purpose of the Study:

• To compare the postoperative hemostasis between Panpharma heparin (®) and Choay heparin (®) in cardiac surgery patients.

Main Methods:

• A retrospective study compared 257 patients who received Panpharma heparin (®) (group P) with 194 patients who received Choay heparin (®) (group C).
• Data on heparin dosage, reoperations for hemostasis, and heparin anti-Xa activity were analyzed.

Main Results:

• Group P received a lower mean heparin dose (21,000 IU/CEC) than group C (22,000 IU/CEC).
• Group P required significantly more surgical re-explorations for hemostasis (3.5% vs. 0%, p=0.01).
• Higher postoperative heparin anti-Xa activity was observed in group P at 1 and 12 hours, explaining the increased bleeding.

Conclusions:

• Variations in anticoagulant activity exist between different heparin manufacturing processes and preparations.
• Surgical teams must be aware that different heparin brands may have unexpected biological effects.
• These variations can potentially compromise patient safety during cardiac surgery.