Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study

A substantial proportion of patients undergoing primary coronary revascularization require homologous transfusions. To address this problem, a comprehensive strategy to diminish perioperative blood loss was developed.

A prospective randomized trial was undertaken to test the hypothesis that "tip-to-tip" heparin-bonded cardiopulmonary bypass circuits (HBC) can further enhance blood conservation and clinical outcomes in patients undergoing primary coronary artery bypass grafting. Two hundred thirty-four patients were treated with either HBC and lower anticoagulation therapy (activated clotting time > 280 seconds) or with conventional, nonheparin-bonded circuits and full anticoagulation therapy (activated clotting time > 480 seconds).

Preoperative and intraoperative risk profiles and characteristics were similar in both groups, with 69.7% of the patients undergoing nonelective coronary artery bypass grafting. Compared with the group with nonheparin-bonded circuits, patients treated with HBC had a lower chest tube output in the first 24 hours (561 +/- 257 versus 651 +/- 403; p = 0.04), were less likely to receive blood products (31.6% versus 47.9%; p = 0.01), and required substantially fewer homologous donor units (1.98 +/- 4.8 versus 4.29 +/- 10.1; p = 0.029). Patients treated with HBC required a shorter duration of ventilatory support (13.2 +/- 16.9 versus 23.4 +/- 50.0 hours; p = 0.04), spent less time in the surgical intensive care unit (20.7 +/- 17.4 versus 35.5 +/- 61.7 hours; p = 0.01), spent fewer days in the hospital (6.0 +/- 2.5 versus 7.3 +/- 5.2 days; p = 0.02), and had fewer postoperative complications (25.6% versus 39.3%; p = 0.03). The use of HBC with a lower anticoagulation protocol was not associated with any adverse events.

This study demonstrates that the use of HBC with a lower anticoagulation protocol in primary coronary artery bypass grafting safely and effectively reduces the incidence and magnitude of homologous transfusion, the duration of ventilation, and surgical intensive care unit and hospital stays.