Different anticoagulation strategies in off-pump coronary artery bypass operations: a European survey

Interact Cardiovasc Thorac Surg. 2008 May;7(3):378-82. doi: 10.1510/icvts.2007.169086. Epub 2008 Feb 26.


In order to determine anticoagulation strategies in OPCAB a questionnaire survey among 750 European cardio-thoracic surgeons was performed. Questions addressed volume of OPCAB procedures performed, intra- and perioperative heparinization and antiplatelet therapy, as well as perioperative management. A total of 325 (43.7%) questionnaires were returned and validated. Perioperative protocols for administration of antiplatelets differed among the respondent surgeons. Perioperative prophylaxis of thrombosis (low or high molecular weight heparin) is performed by 78%. Intraoperative heparin dosage range between 70 U/kg to 500 U/kg, 60% of respondents prefer a low-dose regimen (< or = 150 U/kg). Correspondingly, the lowest activated clotting time (ACT) during surgery is accepted to be 200 s by 24%, 250 s by 18% and 300 s by 26% of surgeons. Protamine is used by 91% of respondents, while 52% perform a 1:1 reversal. A cell-saver and antifibrinolytics are used by 70% and 40%, respectively. Interestingly, 56% of respondents think bleeding in OPCAB patients is not reduced when compared to on-pump CABG. In addition, 34% of respondents believe there is an increased risk of early graft occlusion following OPCAB. This survey demonstrates widely different intra- and perioperative anticoagulation strategies for OPCAB procedures among European surgeons.

Publication types

  • Multicenter Study

MeSH terms

  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Antifibrinolytic Agents / administration & dosage
  • Coronary Artery Bypass, Off-Pump* / adverse effects
  • Drug Administration Schedule
  • Europe
  • Health Care Surveys
  • Heparin / administration & dosage
  • Humans
  • Perioperative Care
  • Platelet Aggregation Inhibitors / administration & dosage
  • Protamines / administration & dosage
  • Risk Assessment
  • Surveys and Questionnaires*
  • Treatment Outcome


  • Anticoagulants
  • Antifibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Protamines
  • Heparin