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British Journal of Anaesthesia, 2001, Vol. 87, No. 6 844-847
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Heparin pretreatment does not alter heparin requirements during cardiopulmonary bypass

S. C. Nicholson1, D. M. Keeling2, M. E. Sinclair1 and R. D. Evans1

1Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. 2Department of Haematology, Churchill Hospital, Headington, Oxford OX3 9LJ, UK*Corresponding author

Heparin infusion may cause heparin resistance and may affect monitoring by measurement of the activated coagulation time (ACT), making the assessment of anticoagulation difficult, with the risk of over- or undertreatment, especially during cardiac surgery. We studied two groups of patients undergoing cardiopulmonary bypass (CPB): patients on heparin infusions (group H) and heparin-naive controls (group C). All patients received heparin 300 IU kg–1 before CPB and a further dose of 5000 IU if the ACT 5 min after commencing bypass was less than 400 s. Measurements of ACT, heparin concentration, antithrombin-3, thrombin–antithrombin complex, prothrombin fragment F1+2 and D-dimers were made before and 5 and 20 min after start of CPB. A second dose of heparin was given to eight out of 18 patients in group C and 10 out of 24 in group H. Antithrombin-3 in group H was significantly less than in group C at 5 min [59 (14) vs 52 (9)%, P<0.05]. ACT was significantly lower in group H than group C at 20 min [387 (64) vs 431 (67) s, P<0.05]. Despite ACTs of less than 400 s in both groups, no coagulation was seen, suggesting that 300 IU kg–1 heparin is a safe dose for anticoagulation in CPB even after heparin therapy.

Br J Anaesth 2001; 87: 844–7


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