Skip to main content
SpringerLink
Log in

Heparin anticoagulation in patients undergoing off-pump and on-pump coronary bypass surgery

  • Original articles
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

The authors analyzed the coagulation data of patients who underwent on-pump coronary artery bypass graft (CABG) or off-pump coronary artery bypass surgery (OPCAB) in a randomized prospective trial.

Methods

CABG and OPCAB patients received heparin anticoagulation at 400 U·kg−1, and 180 U·kg−1 plus 3000 U every 30 min, respectively. In addition, OPCAB patients received a rectal aspirin, 650 mg, during the procedure. Perioperative coagulation test results (platelet count, fibrinogen, prothrombin time, partial thromboplastin time [PTT], activated clotting time [ACT], and thromboelastography [TEG; Haemoscope] were collected from CABG (n = 99) and OPCAB (n = 98) patients. Residual heparin activity after protamine was measured, using an anti-activated factor X (Xa) assay, in 10 patients from each group.

Results

Our study showed that the current anticoagulation regimen in the OPCAB patients achieved a peak ACT of 445 ± 73 s, and it preserved platelet counts and fibrinogen levels. A residual heparin effect was detected, with residual anti-Xa heparin activity of 0.2 U·ml−1 up to 2 h after surgery in the OPCAB group. Despite the residual anticoagulation, the OPCAB group had a similar TEG index of native blood, postoperative chest tube drainage, and non-erythrocyte transfusion rate as compared with the CABG group.

Conclusion

We have shown that the heparin anticoagulation regimen in OPCAB patients does not lead to an immediate hypercoagulable state. Total doses of heparin and protamine were lower in the OPCAB group compared with the CABG group, and there was a residual heparin effect on TEG and PTT in the early postoperative period in the OPCAB group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. GD Angelini FC Taylor BC Reeves R Ascione (2002) ArticleTitleEarly and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials Lancet 359 1194–1199 Occurrence Handle11955537 Occurrence Handle10.1016/S0140-6736(02)08216-8

    Article  PubMed  Google Scholar 

  2. JD Puskas VH Thourani JJ Marshall SJ Dempsey MA Steiner BH Sammons IW Brown JP Gott WS Weintraub RA Guyton (2001) ArticleTitleClinical outdcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients Ann Thorac Surg 71 1477–1483 Occurrence Handle11383786 Occurrence Handle10.1016/S0003-4975(01)02473-0 Occurrence Handle1:STN:280:DC%2BD3MzhtVelsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  3. JD Puskas WH Williams PG Duke JR Staples KE Glas JJ Marshall M Leimbach P Huber S Garas BH Sammons SA McCall RJ Petersen DE Bailey H Chu EM Mahoney WS Weintraub RA Guyton BW Lytle LI Bonchek (2003) ArticleTitleOff-pump coronary artery bypass grafting provides complete revascularization with reduced mycocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of 200 unselected patients undergoing off-pump versus conventional coronary artery bypass grafting J Thorac Cardiovasc Surg 125 797–808 Occurrence Handle12698142 Occurrence Handle10.1067/mtc.2003.324 Occurrence Handle1:STN:280:DC%2BD3s7nvFWqtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. R Cartier D Robitaille (2001) ArticleTitleThrombotic complications in beating heart operations J Thorac Cardiovasc Surg 121 920–922 Occurrence Handle11326235 Occurrence Handle10.1067/mtc.2001.113177 Occurrence Handle1:STN:280:DC%2BD3MzisFyitA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. YJ GU MA Mariani PW Boonstra JG Grandjean W van Oeveren (1999) ArticleTitleComplement activation in coronary artery bypass grafting patients without cardiopulmonary bypass: the role of tissue injury by surgical incision Chest 116 892–898 Occurrence Handle10531149 Occurrence Handle10.1378/chest.116.4.892 Occurrence Handle1:STN:280:DC%2BD3c%2FgtlWrsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  6. V Casati C Gerli A Franco G Torri A D'Angelo S Benussi O Alfieri (2001) ArticleTitleTranexamic acid in off-pump coronary surgery: a preliminary, randomized, double-blind, placebo-controlled study Ann Thorac Surg 72 470–475 Occurrence Handle11515884 Occurrence Handle10.1016/S0003-4975(01)02802-8 Occurrence Handle1:STN:280:DC%2BD3MvntFaksA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. MA Mariani YJ GU PW Boonstra JG Grandjean W van Oeveren T Ebels (1999) ArticleTitleProcoagulant activity after off-pump coronary operation: is the current anticoagulation adequate? Ann Thorac Surg 67 1370–1375 Occurrence Handle10355414 Occurrence Handle10.1016/S0003-4975(99)00265-9 Occurrence Handle1:STN:280:DyaK1M3otFGntw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. L Englberger P Markart FS Eckstein FF Immer PA Berdat TP Carrel (2002) ArticleTitleAprotinin reducers blood loss in off-pump coronary artery bypass (OPCAB) surgery Eur J Cardiothorac Surg 22 545–551 Occurrence Handle12297170 Occurrence Handle10.1016/S1010-7940(02)00433-5 Occurrence Handle1:STN:280:DC%2BD38vos1Oisg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. RL Quigley DW Fried R Salenger J Pym RY Highbloom (2002) ArticleTitleThrombelastographic changes in OPCAB surgical patients Perfusion 17 363–367 Occurrence Handle12243441 Occurrence Handle10.1191/0267659102pf600oa Occurrence Handle1:STN:280:DC%2BD38votFGhuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  10. L Englberger FF Immer FS Eckstein PA Berdat A Haeberli TP Carrel (2004) ArticleTitleOff-pump coronary artery bypass operation does not increase procoagulant and fibrinolytic activity: preliminary results Ann Thorac Surg 77 1560–1566 Occurrence Handle15111143 Occurrence Handle10.1016/j.athoracsur.2003.10.061

    Article  PubMed  Google Scholar 

  11. R Poston J GU J Brown J Gammie C White J Manchio RN Pierson BP Griffith P Gurbel U Tandry TB Gilbert (2005) ArticleTitleHypercoagulability affecting early vein graft patency does not exist after off-pump coronary artery bypass J Cardiothorac Vasc Anesth 19 11–18 Occurrence Handle15747263 Occurrence Handle10.1053/j.jvca.2004.11.003

    Article  PubMed  Google Scholar 

  12. JD Puskas WH Williams EM Mahoney PR Huber PC Block PG Duke JR Staples KE Glas JJ Marshall ME Leimbach SA McCall RJ Petersen DE Bailey WS Weintraub RA Guyton (2004) ArticleTitleOff-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial JAMA 291 1841–1849 Occurrence Handle15100202 Occurrence Handle10.1001/jama.291.15.1841 Occurrence Handle1:CAS:528:DC%2BD2cXjsVSmu7g%3D

    Article  PubMed  CAS  Google Scholar 

  13. G Dangas JD Marmur TE King J De Leon SK Sharma R Vidhun D Feldman MY Stoynov JJ Badimon JA Ambrose (1999) ArticleTitleEffects of platelet glycoprotein IIIb/IIa inhibition with abciximab on thrombin generation and activity during percutaneous coronary intervention Am Heart J 138 49–54 Occurrence Handle10385763 Occurrence Handle10.1016/S0002-8703(99)70245-0 Occurrence Handle1:CAS:528:DyaK1MXltVWks7s%3D

    Article  PubMed  CAS  Google Scholar 

  14. JA Ambrose M Hawkey JJ Badimon J Coppola J Geagea KP Rentrop A Domiguez S Duvvuri T Elmquist J Arias R Doss G Dangas (2000) ArticleTitleIn vivo deomonstration of an antithrombin effect of abciximab Am J Cardiol 86 150–152 Occurrence Handle10913474 Occurrence Handle10.1016/S0002-9149(00)00851-1 Occurrence Handle1:CAS:528:DC%2BD3cXksFekur4%3D

    Article  PubMed  CAS  Google Scholar 

  15. JA Ambrose R Doss JM Geagea MC Hawkey S Duvuri K Giedd A Dominguez J Coppola TH Nguyen V Palla RS Barua DC Saha (2001) ArticleTitleEffects on thrombin generation of the platelet glycoprotein IIb/IIIa inhibitors abciximab versus tirofiban during coronary intervention Am J Cardiol 87 1231–1233 Occurrence Handle11356410 Occurrence Handle10.1016/S0002-9149(01)01506-5 Occurrence Handle1:CAS:528:DC%2BD3MXjsFehur4%3D

    Article  PubMed  CAS  Google Scholar 

  16. SC Smith SuffixJr TE Feldman JW Hirshfeld SuffixJr AK Jacobs MJ Kern SB King Suffix3rd DA Morrison WW O'Neill HV Schaff PL Whitlow DO Williams EM Antman SC Smith SuffixJr CD Adams JL Anderson DP Faxon V Fuster JL Halperin LF Hiratzka SA Hunt AK Jacobs R Nishimura JP Ornato RL Page B Riegel (2006) ArticleTitleAmerican College of C, American Heart Association Task Force on Prantice G, Intervention SWCtUtGfPC: ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) J Am Coll Cardiol 47 e1–121 Occurrence Handle16386656 Occurrence Handle10.1016/j.jacc.2005.12.001

    Article  PubMed  Google Scholar 

  17. GJ Despotis JH Joist CW Hogue A Alsoufiev D Joiner-Maier SA Santoro E Spitznagel JI Weitz LT Goodnough (1996) ArticleTitleMore effective suppression of hemostatic system activation in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather than ACT Thromb Haemost 76 902–908 Occurrence Handle8972009 Occurrence Handle1:CAS:528:DyaK2sXjvVChsQ%3D%3D

    PubMed  CAS  Google Scholar 

  18. JD Levy GJ Despotis F Szlam P Olson D Meeker A Weisinger (2002) ArticleTitleRecombinant human transgenic antithrombin in cardiac surgery: a dose-finding study Anesthesiology 96 1095–1102 Occurrence Handle11981148 Occurrence Handle10.1097/00000542-200205000-00011 Occurrence Handle1:CAS:528:DC%2BD38Xkt1Ckurg%3D

    Article  PubMed  CAS  Google Scholar 

  19. MD Boisclair DA Lane H Philippou MP Esnouf S Sheikh B Hunt KJ Smith (1993) ArticleTitleMechanisms of thrombin generation during surgery and cardiopulmonary bypass Blood 82 3350–3357 Occurrence Handle8241505 Occurrence Handle1:STN:280:DyaK2c%2FmtVelug%3D%3D

    PubMed  CAS  Google Scholar 

  20. SJ Davidson JF Burman LC Rutherford BF Keogh MH Yacoub (2001) ArticleTitleHigh molecular wight kininogen deficiency: a patient who underwent cardiac surgery Thromb Haemost 85 195–197 Occurrence Handle11246531 Occurrence Handle1:CAS:528:DC%2BD3MXhvVKku7Y%3D

    PubMed  CAS  Google Scholar 

  21. JF Burman HI Chung DA Lane H Philippou A Adami JC Lincoln (1994) ArticleTitleRole of factor XII in thrombin generation and fibrinolysis during cardiopulmonary bypass Lancet 344 1192–1193 Occurrence Handle7934541 Occurrence Handle10.1016/S0140-6736(94)90509-6 Occurrence Handle1:STN:280:DyaK2M%2FitVagsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. JH Chung N Gikakis AK Rao TA Drake RW Colman LH Edmunds SuffixJr (1996) ArticleTitlePericardial blood activates the extrinsic coagulation pathway during clinical cardiopulmonary bypass Circulation 92 2014–2018

    Google Scholar 

  23. P Olsson H Lagergren S Ek (1963) ArticleTitleThe elimination from plasma of intravenous heparin: an experimental study on dogs and humans Acta Med Scand 173 613–630

    Google Scholar 

  24. BS Bull WM Huse FS Brauer RA Korpman (1975) ArticleTitleHeparin therapy during extracorporeal circulation. II. The use of a dose-response curve to individualize heparin and protamine dosage J thorac Cardiovasc Surg 69 685–689 Occurrence Handle1127967 Occurrence Handle1:STN:280:DyaE2M7lsVKltw%3D%3D

    PubMed  CAS  Google Scholar 

  25. GA Nuttall WC Oliver PJ Santrach S Bryant JA Dearani HV Schaff MH Ereth (2001) ArticleTitleEfficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass Anesthesiology 94 773–781 Occurrence Handle11388527 Occurrence Handle10.1097/00000542-200105000-00014 Occurrence Handle1:STN:280:DC%2BD3MzhsVKrsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. SM Klein TF Slaughter PT Vail B Ginsberg HE El-Moalem R Alexander F D'Ercole RA Greengrass TTM Perumal I Welsby TJ Gan (2000) ArticleTitleThromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations Anesth anale 91 1091–1095 Occurrence Handle10.1097/00000539-200011000-00009 Occurrence Handle1:CAS:528:DC%2BD3cXot1Sltbs%3D

    Article  CAS  Google Scholar 

  27. MM Nowak B Brundhofer M Gibaldi (1974) ArticleTitleRectal absorption from aspirin suppositories in children and adults Pediatrics 54 23–26 Occurrence Handle4834297 Occurrence Handle1:CAS:528:DyaE2cXlsVGqsbk%3D

    PubMed  CAS  Google Scholar 

  28. J Kanto J Klossner R Mantyla T Yrjana (1981) ArticleTitleBiovailability of rectal aspirin in neurosurgical patients Acta Anaesthesiol Scand 25 25–26 Occurrence Handle7293702 Occurrence Handle1:STN:280:DyaL38%2Fkt1OhtA%3D%3D Occurrence Handle10.1111/j.1399-6576.1981.tb01600.x

    Article  PubMed  CAS  Google Scholar 

  29. N Zimmermann P Kienzle AA Weber J Winter E Gams K Schror T Hohlfeld (2001) ArticleTitleAspirin resistance after coronary artery bypass grafting J Thorac Cardiovasc Surg 121 982–984 Occurrence Handle11326244 Occurrence Handle10.1067/mtc.2001.111416 Occurrence Handle1:STN:280:DC%2BD3MzisFyhsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  30. US Tantry KP Bliden PA Gurbel (2005) ArticleTitleResistance to antiplatelet drugs: current status and future research Expert Opin Pharmacother 6 2027–2045 Occurrence Handle16197357 Occurrence Handle10.1517/14656566.6.12.2027 Occurrence Handle1:CAS:528:DC%2BD2MXhtFCjsbjI

    Article  PubMed  CAS  Google Scholar 

  31. R Poston J GU J Manchio A Lee J Brown J Gammie C White BP Griffith (2005) ArticleTitlePlatelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting Eur J Cardiothorac Surg 27 584–591 Occurrence Handle15784355 Occurrence Handle10.1016/j.ejcts.2004.12.061

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, N.E., Atlanta, GA, 30322, USA

    Kenichi A. Tanaka, Peggy G. Duke & Jerrold H. Levy

  2. Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Vinod H. Thourani, Willis H. Williams, Robert A. Guyton & John D. Puskas

Authors
  1. Kenichi A. Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vinod H. Thourani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Willis H. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peggy G. Duke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jerrold H. Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert A. Guyton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John D. Puskas
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Tanaka, K., Thourani, V., Williams, W. et al. Heparin anticoagulation in patients undergoing off-pump and on-pump coronary bypass surgery. J Anesth 21, 297–303 (2007). https://doi.org/10.1007/s00540-007-0506-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-007-0506-1

Key words

Search

Navigation