Reappearance of circulating heparin in whole blood heparin concentration-based management does not correlate with postoperative bleeding after cardiac surgery.

Abstract

OBJECTIVE:

The Hepcon Heparin Management System (HMS) facilitates administration of higher heparin and lower protamine doses, which may affect bleeding potential due to heparin rebound. The present study evaluated heparin rebound in patients for whom the Hepcon HMS was used to determine whether point-of-care tests detect residual heparin and residual heparin is associated with postoperative blood loss.

DESIGN:

Prospective study.

SETTING:

Tertiary care center affiliated with a university hospital.

PARTICIPANTS:

Adults undergoing elective cardiac surgery requiring cardiopulmonary bypass.

INTERVENTIONS:

In blood samples obtained at baseline, at 2 minutes, and at 1, 2, 4, 6, and 24 hours after heparin neutralization, heparin concentrations were measured using an automated chromogenic assay. Activated coagulation time (ACT), activated partial thromboplastin time (APTT), and thromboelastometry 2 hours after heparin neutralization also were examined in the last 22 study patients enrolled.

MEASUREMENTS AND MAIN RESULTS:

All 31 patients had measurable heparin levels 2 hours after protamine administration; 22 patients exhibited a primary failure to reverse heparin after protamine administration, and 9 patients had measureable heparin levels 2 hours after complete heparin reversal (ie, heparin rebound). The thromboelastometric variable, INTEM-CT:HEPTEM-CT ratio, correlated with heparin concentration (r=0.72), but ACT (r=-0.12), APTT (r=0.36), and whole blood heparin concentration, determined using the Hepcon HMS, did not. Peak heparin concentration (0.18±0.07 U/mL) at 4 hours was not correlated with mediastinal blood loss.

CONCLUSION:

Circulating heparin detected by the chromogenic assay was too low to be clinically significant based on postoperative bleeding, although all 31 patients had residual heparin or heparin rebound at 2 hours after protamine administration with use of the Hepcon HMS.

• Authors: Junko Ichikawa, Mitsuharu Kodaka, Keiko Nishiyama, Yuji Hirasaki, Makoto Ozaki, Makiko Komori
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 28 Issue 4 Pg. 1003-7 (Aug 2014) ISSN: 1532-8422 [Electronic] United States
• PMID: 24508375 (Publication Type: Journal Article)
• Copyright: © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Biomarkers
• Heparin

Topics

• Aged
• Anticoagulants (adverse effects, pharmacokinetics)
• Biomarkers (blood)
• Cardiac Surgical Procedures (adverse effects)
• Female
• Follow-Up Studies
• Heart Diseases (surgery)
• Heparin (adverse effects, pharmacokinetics)
• Humans
• Incidence
• Japan (epidemiology)
• Male
• Postoperative Hemorrhage (blood, chemically induced, epidemiology)
• Prospective Studies
• Recurrence
• Thrombosis (prevention & control)