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Related Experiment Videos

Postoperative bleeding in cardiovascular surgery. Does heparin rebound really exist?

S R Gundry1, R A Drongowski, M D Klein

  • 1Department of Surgery, University of Michigan Hospitals, Ann Arbor.

The American Surgeon
|March 1, 1989
PubMed
Summary

Heparin rebound after cardiovascular surgery is often misdiagnosed. A new chemical assay indicates heparin rebound is rare, preventing dangerous protamine sulfate overuse.

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Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Pharmacology

Background:

  • Postoperative bleeding after cardiovascular procedures is a significant clinical challenge.
  • Heparin reversal with protamine sulfate is standard, but heparin rebound is frequently suspected.
  • Current diagnostic methods rely on biologic clotting tests, which can be unreliable postoperatively.

Purpose of the Study:

  • To investigate the actual incidence of heparin rebound after cardiac bypass surgery.
  • To evaluate the utility of a new chemical assay for plasma heparin levels.

Main Methods:

  • A cohort of 27 patients undergoing coronary artery bypass grafting were studied.
  • Plasma heparin levels were measured using the Azure A assay at baseline and serially for 8 hours post-bypass.

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  • Prothrombin time (PT) and partial thromboplastin time (PTT) were measured concurrently.

    • Main Results:

    • Out of 252 samples, only one showed measurable heparin (0.4%) outside the immediate post-bypass period.
    • This single positive sample normalized within 30 minutes.
    • Biologic clotting tests (PT/PTT) were not detailed in the provided abstract snippet.

    Conclusions:

    • Heparin rebound appears to be a rare event after cardiac bypass surgery.
    • The Azure A assay provides a reliable chemical measurement of heparin.
    • Over-treatment with protamine sulfate due to misinterpretation of heparin rebound may be common.