BACKGROUND:
Individualized heparin management (IHM) uses heparin dose-response curves to improve hemostasis management during cardiac surgery compared to activated clotting time based methods.
OBJECTIVES:
IHM was compared against conventional hemostasis management (CHM) in a randomized, prospective study (ID DRKS00007580).
METHODS:
120 patients undergoing multivessel coronary artery bypass grafting (CABG) were enrolled. Heparin and protamine consumption, bloodlosses, blood transfusions, and administration of hemostatic agents were recorded. Time courses of platelet counts and of coagulation parameters were determined. Coagulation was analyzed at ICU arrival by thrombelastometry.
RESULTS:
IHM patients received significantly lower initial heparin doses (289.3 [221.5-376.2] IU/kg vs. 350.5 [346.8-353.7] IU/kg, p<0.0001) but similar total heparin doses (418.5 [346.9-590.5] IU/kg vs 435.8 [411.7-505.1]). IHM patients received significantly less protamine, resulting in protamine:total heparin ratios of 0.546 [0.469-0.597] vs. 0.854 [0.760-0.911] in CHM patients (p<0.0001). Activated partial thromboplastin time (50.5 [40.0-60.0] vs. 37.0 s [33.0-40.0], p<0.0001), activated clotting time (136 [129.0-150.5] vs. 126.5 s [120.3-134.0], p=0.0002), and INTEM clotting times (215 [192-237] vs. 201 s [191-216], p=0.0397) were significantly longer in IHM compared to CHM at ICU arrival, with no difference in prothrombin time (p=0.538). IHM patients lost significantly more blood within 12 h post-op (420 [337.5-605.0] vs. 345 ml [230.0-482.5], p=0.0041) and required significantly more hemostatic agents to control bleeding. Red blood cell transfusion requirements as well as time courses of platelet counts did not differ between groups.
CONCLUSIONS:
Multivessel CABG patients did not benefit from individualized heparin management in comparison to our established protocol based on activated clotting time. This article is protected by copyright. All rights reserved.
