Relationships between antithrombin activity, anticoagulant efficacy of heparin therapy and perioperative variables in patients undergoing cardiac surgery requiring cardiopulmonary bypass

Perfusion. 2011 Nov;26(6):487-95. doi: 10.1177/0267659111412999. Epub 2011 Jun 10.

Abstract

Introduction: A study on 149 cardiopulmonary bypass (CPB) patients was performed to elucidate possible relationships between antithrombin (AT) activity and a subject's clinical profile or surgery characteristics.

Methods: An initial dose (300 IU/kg) of heparin was administered before CPB. Additional boluses (100 IU/kg) were administered if the activated clotting time (ACT)≤460 s. AT activity and hematological parameters were determined preoperatively, during and after CPB, and at 12, 24, 36, and 48 hours post-intervention.

Results: 29.5% patients required an additional dose of heparin during CPB. Preoperative AT was 96.5 ± 13.9% in all but 4 patients. AT was significantly lower during CPB and upon leaving the operating room (59.7%-80.0%). A small, but significant, inverse correlation was observed between AT at the end of CPB and the patient's age, as well as between basal preoperative AT and total heparin administered.

Conclusions: Patient's age could be a moderate indicator of AT activity drop and low preoperative AT activity could be a sign of reduced anticoagulant efficacy of heparin during CPB.

MeSH terms

  • Aged
  • Anticoagulants / pharmacology
  • Anticoagulants / therapeutic use*
  • Antithrombin III / metabolism
  • Antithrombins / pharmacology
  • Antithrombins / therapeutic use*
  • Blood Coagulation / drug effects
  • Blood Coagulation Tests
  • Cardiac Surgical Procedures* / methods
  • Cardiopulmonary Bypass* / methods
  • Female
  • Heparin / pharmacology
  • Heparin / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Whole Blood Coagulation Time

Substances

  • Anticoagulants
  • Antithrombins
  • Antithrombin III
  • Heparin