Identifying optimal heparin management during cardiopulmonary bypass in Chinese people: a retrospective observational comparative study
- 31 Downloads
Traditionally heparin is adapted according to total body weight (TBW) to providing anticoagulation during cardiopulmonary bypass (CPB), but it may be inaccurate in some patients. The medical records of 100 adult patients who received CPB in Tongji Hospital of Tongji Medical College Huazhong University of Science and Technology over a 10-month period in 2017 were included in the retrospective study. An unfractionated heparin (UFH) bolus of 300 IU/kg TBW was injected before initiation of CPB followed by additional doses (50 to 100 IU/kg) to maintain a target activated coagulation time (ACT) of at least 480 s. We used TBW, ideal body weight (IBW), lean body weight (LBW), or body mass index (BMI) to establish and evaluate a linear model of ACT and the amount of heparin respectively. The linear fit effect of the model based on BMI on the original data is better than the others. As the instruments to measure heparin concentration is unavailable in most medical institutions in China. The new linear model based on BMI is helpful to estimate a more individualized heparin dosage in the heparinized phase and to provide useful reference to the amount of remaining heparin in the neutralization phase.
KeywordsHeparin Cardiopulmonary bypass Anticoagulants Body mass index
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YG, ZY and CZ. The first draft of the manuscript was written by YG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
Both authors declare that they have no conflict of interest.
This retrospective observational study was approved on 5 July 2018 by the Medicine Ethics Committee of Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (approved number TJ-IRB20180614) and was declared to Chinese Clinical Trial Register (registration number ChiCTR1800015143).
The personal information that helps identify patients in all cases is removed during the data collection. The Medicine Ethics Committee of Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology permitted the requirement for written informed consent was waived.
- 2.Haas E, Fischer F, Levy F, Degirmenci SE, Grunebaum L, Kindo M, Collange O, Mertes PM, Steib A (2016) Identifying optimal heparin management during cardiopulmonary bypass in obese patients: a prospective observational comparative study. Eur J Anaesthesiol 33(6):408–416. https://doi.org/10.1097/eja.0000000000000431 CrossRefPubMedGoogle Scholar
- 3.Meesters MI, Veerhoek D, de Lange F, de Vries JW, de Jong JR, Romijn JW, Kelchtermans H, Huskens D, van der Steeg R, Thomas PW, Burtman DT, van Barneveld LJ, Vonk AB, Boer C (2016) Effect of high or low protamine dosing on postoperative bleeding following heparin anticoagulation in cardiac surgery. A randomised clinical trial. Thromb Haemost 116(2):251–261. https://doi.org/10.1160/th16-02-0117 CrossRefPubMedGoogle Scholar
- 4.Shore-Lesserson L, Baker RA, Ferraris VA, Greilich PE, Fitzgerald D, Roman P, Hammon JW (2018) The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: clinical practice guidelines-anticoagulation during cardiopulmonary bypass. Ann Thorac Surg 105(2):650–662. https://doi.org/10.1016/j.athoracsur.2017.09.061 CrossRefPubMedGoogle Scholar
- 7.Vienne M, Haas E, Wipf T, Grunebaum L, Levy F, Sattler L, Hoang Minh T, Severac F, Tacquard C, Collange O, Mertes PM, Steib A (2018) Adjusted calculation model of heparin management during cardiopulmonary bypass in obese patients: a randomised controlled trial. Eur J Anaesthesiol. https://doi.org/10.1097/eja.0000000000000784 CrossRefPubMedGoogle Scholar
- 8.Zhang Y, Liu K, Li W, Xue Q, Hong J, Xu J, Wu L, Ji G, Sheng J, Wang Z (2016) An adjusted calculation model of reduced heparin doses in cardiopulmonary bypass surgery in a Chinese population. J Cardiothorac Vasc Anesth 30(5):1179–1183. https://doi.org/10.1053/j.jvca.2016.04.005 CrossRefPubMedGoogle Scholar
- 10.Gruenwald CE, Manlhiot C, Chan AK, Crawford-Lean L, Foreman C, Holtby HM, Van Arsdell GS, Richards R, Moriarty H, McCrindle BW (2010) Randomized, controlled trial of individualized heparin and protamine management in infants undergoing cardiac surgery with cardiopulmonary bypass. J Am Coll Cardiol 56(22):1794–1802. https://doi.org/10.1016/j.jacc.2010.06.046 CrossRefPubMedGoogle Scholar
- 12.Rakusa M, Jensterle M, Bozic-Mijovski M, Janez A (2017) Increased coagulation and decreased fibrinolysis as measured with overall hemostatic potential are dependent on BMI and not associated with PCOS. Metab Syndr Relat Disord 15(4):194–198. https://doi.org/10.1089/met.2016.0148 CrossRefPubMedGoogle Scholar
- 13.Kornblith LZ, Howard B, Kunitake R, Redick B, Nelson M, Cohen MJ, Callcut R (2015) Obesity and clotting: body mass index independently contributes to hypercoagulability after injury. J Trauma Acute Care Surg 78(1):30–36. https://doi.org/10.1097/ta.0000000000000490(discussion 37–38) CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Delavenne X, Ollier E, Chollet S, Sandri F, Lanoiselee J, Hodin S, Montmartin A, Fuzellier JF, Mismetti P, Gergele L (2017) Pharmacokinetic/pharmacodynamic model for unfractionated heparin dosing during cardiopulmonary bypass. Br J Anaesth 118(5):705–712. https://doi.org/10.1093/bja/aex044 CrossRefPubMedGoogle Scholar