Histamine blockade and cardiovascular changes following heparin administration during cardiac surgery

1990 ◽  
Vol 4 (6) ◽  
pp. 711-714 ◽  
Author(s):  
Pierre A. Casthely ◽  
Dushana Yoganathan ◽  
Bill Karyanis ◽  
Mary Salem ◽  
Thil Yoganathan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiovascular Changes ◽  
Heparin Administration

Changes in heparin dose response slope during cardiac surgery: possible result in inaccuracy in predicting heparin bolus dose requirement to achieve target ACT

Perfusion ◽  
2017 ◽  
Vol 32 (6) ◽  
pp. 474-480 ◽  
Author(s):  
Junko Ichikawa ◽  
Tetsu Mori ◽  
Mitsuharu Kodaka ◽  
Keiko Nishiyama ◽  
Makoto Ozaki ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Dose Response ◽  
Complete Blood Count ◽  
Activity Level ◽  
Heparin Dose ◽  
Dose Requirement ◽  
Heparin Concentration ◽  
Heparin Administration

Introduction: The substantial interpatient variability in heparin requirement has led to the use of a heparin dose response (HDR) technique. The accuracy of Hepcon-based heparin administration in achieving a target activated clotting time (ACT) using an HDR slope remains controversial. Methods: We prospectively studied 86 adult patients scheduled for cardiac surgery requiring cardiopulmonary bypass. The total dose of calculated heparin required for patient and pump priming was administered simultaneously to achieve a target ACT of 450 s for HDR on the Hepcon HMS system. Blood samples were obtained after the induction of anesthesia, at 3 min after heparin administration and after the initiation of CPB to measure kaolin ACT, HDR slope, whole-blood heparin concentration based on the HDR slope and anti-Xa heparin concentration, antithrombin and complete blood count. Results: The target ACT of 450 s was not achieved in 68.6% of patients. Compared with patients who achieved the target ACT, those who failed to achieve their target ACT had a significantly higher platelet count at baseline. Correlation between the HDR slope and heparin sensitivity was poor. Projected heparin concentration and anti-Xa heparin concentration are not interchangeable based on the Bland–Altman analysis. Conclusion: It can be hypothesized that the wide discrepancy in HDR slope versus heparin sensitivity may be explained by an inaccurate prediction of the plasma heparin level and/or the change in HDR of individual patients, depending on in vivo factors such as extravascular sequestration of heparin, decreased intrinsic antithrombin activity level and platelet count and/or activity.

scholarly journals A case of heparin induced thrombocytopenia managed by Rivaroxaban

2021 ◽  
Author(s):  
Ali Eshraghi ◽  
Faeze Keihanian
Keyword(s):  
Cardiac Surgery ◽  
Oral Anticoagulant ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Administration ◽  
New Oral Anticoagulant ◽  
Increased Risk

Heparin-induced thrombocytopenia (HIT) is an immunogenic disorder. It can lead to thrombocytopenia and a hypercoagulated state with an increased risk for new thrombosis. We here reported a 49-year-old man with previous cardiac surgery and heparin administration, treated by new oral anticoagulant agent, Rivaroxaban.

A reduction of prothrombin conversion by cardiac surgery with cardiopulmonary bypass shifts the haemostatic balance towards bleeding

2016 ◽  
Vol 116 (09) ◽  
pp. 442-451 ◽  
Author(s):  
Yvonne P. J. Bosch ◽  
Saartje Bloemen ◽  
Bas de Laat ◽  
Patrick W. Weerwind ◽  
Bas Mochtar ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
In Silico ◽  
Thrombin Generation ◽  
Coagulation Factor ◽  
Thrombin Inhibition ◽  
Relative Contribution ◽  
Post Surgery ◽  
Heparin Administration ◽  
Thrombotic Complications

SummaryCardiac surgery with cardiopulmonary bypass (CPB) is associated with blood loss and post-surgery thrombotic complications. The process of thrombin generation is disturbed during surgery with CPB because of haemodilution, coagulation factor consumption and heparin administration. We aimed to investigate the changes in thrombin generation during cardiac surgery and its underlying pro- and anticoagulant processes, and to explore the clinical consequences of these changes using in silico experimentation. Plasma was obtained from 29 patients undergoing surgery with CPB before heparinisation, after heparinisation, after haemodilution, and after protamine administration. Thrombin generation was measured and prothrombin conversion and thrombin inactivation were quantified. In silico experimentation was used to investigate the reaction of patients to the administration of procoagulant factors and/or anticoagulant factors. Surgery with CPB causes significant coagulation factor consumption and a reduction of thrombin generation. The total amount of prothrombin converted and the rate of prothrombin conversion decreased during surgery. As the surgery progressed, the relative contribution of α2-macroglobulin-dependent thrombin inhibition increased, at the expense of antithrombin-dependent inhibition. In silico restoration of post-surgical prothrombin conversion to pre-surgical levels increased thrombin generation excessively, whereas co-administration of antithrombin resulted in the normalisation of post-surgical thrombin generation. Thrombin generation is reduced during surgery with cardiopulmonary bypass because of a balance shift between prothrombin conversion and thrombin inactivation. According to in silico predictions of thrombin generation, this new balance increases the risk of thrombotic complications with prothrombin complex concentrate administration, but not if antithrombin is co-administered.

scholarly journals Evaluation of a New Sonoclot Device for Heparin Management in Cardiac Surgery

2016 ◽  
Vol 23 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Omer Dzemali ◽  
Michael T. Ganter ◽  
Alicja Zientara ◽  
Kirk Graves ◽  
Renate Behr ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Glass Bead ◽  
Percentage Error ◽  
Altman Analysis ◽  
Clotting Time ◽  
Bland Altman Analysis ◽  
New Device ◽  
Activated Clotting Time ◽  
Heparin Administration ◽  
Target Values

Background: Sonoclot is used to measure kaolin-based activated clotting time (kACT) for heparin management. Apart from measuring kACT, the device assesses the patient’s coagulation status by glass bead–activated tests (gbACTs; measuring also clot rate [CR] and platelet function [PF]). Recently, a new version of the Sonoclot has been released, and the redesign may result in performance changes. The aim of this study was to evaluate and compare the performance of the new (S2) and the previous (S1) Sonoclot. Methods: The S1 was used in the routine management of 30 patients undergoing elective cardiac surgery. Blood samples were taken at baseline (T1), after heparin administration (200 U/kg, 100 U/kg; T2 and T3), during cardiopulmonary bypass (T4), after protamine infusion (T5), and before intensive care unit transfer (T6). Kaolin-based activated clotting time and gbACTs were measured in duplicate by both the old and the new device and performance compared by Bland-Altman analysis and percentage error calculation. Results: A total of 300 kACT and 180 gbACTs were available. Bland-Altman analysis for kACT revealed that S2 consistently reported results in shorter time compared to S1 (overall = −14.7%). Comparing S2 and S1, the glass bead–activated tests showed mean percentage differences of −18.9% (gbACTs), +37.4% (CR), and −3.7% (PF). Conclusion: Since clotting is faster in the new S2 compared to S1, shorter clotting times have to be considered in clinical practice. The use of S2 kACT in heparin management will result in higher heparin and protamine dosing unless heparin kACT target values are adjusted to correct for the differences in results between S1 and S2.

Preoperative Heparin Therapy Causes Immune-Mediated Hypotension Upon Heparin Administration for Cardiac Surgery

2010 ◽  
Vol 24 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Pierre A. Casthely ◽  
Vincent Defilippi ◽  
Lorraine Cornwell ◽  
Zachary Samuel ◽  
Thil Yoganathan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heparin Therapy ◽  
Heparin Administration ◽  
Immune Mediated

scholarly journals Different Approaches to Reduce Bleeding of a Hemophilia-A Patient during Cardiac Surgery

2021 ◽  
pp. 1-4
Author(s):  
Kianoush Saberi ◽  
Kianoush Saberi ◽  
Alireza Bakhshandeh ◽  
Shahnaz Sharifi ◽  
Mehrdad Salehi
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Septal Defect ◽  
Hemophilia A ◽  
Coagulation System ◽  
Significant Challenge ◽  
Heparin Administration

A 16-year-old hemophilia-A patient presented with symptomatic atrial septal defect (ASD). Managing bleeding during cardiovascular surgeries is a significant challenge, even for none-hemophilic patients, due to heparin administration, cardiopulmonary bypass (CPB) coagulopathy and surgical complications. This essay is an effort to discuss ASD, CPB effects on the coagulation system, and highlight some approaches to lower bleeding in hemophilic patients with congenital heart disease.

scholarly journals An Exploratory, Observational Cohort Study on the Dynamics of Heparin Binding Protein in Cardiothoracic Surgery Using Cardiopulmonary Bypass

2020 ◽  
Author(s):  
Niklas Sterner ◽  
Jane Fisher ◽  
Louise Thelaus ◽  
Carolin Ketteler ◽  
Špela Lemež ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Organ Dysfunction ◽  
Binding Protein ◽  
Surgical Trauma ◽  
Heparin Binding ◽  
Postoperative Infections ◽  
Heparin Binding Protein ◽  
Heparin Administration ◽  
Protamine Administration

Abstract BackgroundSurgical trauma and cardiopulmonary bypass (CPB) cause an inflammatory response, difficult to differentiate from postoperative infections. Heparin-binding protein (HBP) is released from neutrophils and has been shown to predict infection-related organ dysfunction and disease progression to severe sepsis. In order to explore the potential of HBP as a biomarker for postoperative infections and asess possible confounding effects of concomitant medications, this study aimed to investigate the pre-, intra- and postoperative dynamics of HBP in cardiac surgery with CPB.Methods Thirty patients undergoing cardiac surgery with CPB were included, of which 15 underwent coronary artery bypass grafting (CABG) surgery and 15 underwent complex procedures with longer CPB duration. Ten patients undergoing lung surgery without CPB were also included as a conventional surgery reference group. HBP was measured at nine different perioperative time points.Results Our results showed that HBP levels were not affected by surgical trauma by itself. An increase in HBP levels was observed immediately following heparin administration and further increased during CPB. Prior to protaminization, we measured higher peak HBP-levels in the complex group (345.7 (287.8-472.6) ng/mL) compared with the CABG group (152.7 (85.3-204.0) ng/mL, p<0.001). HBP decreased rapidly following cessation of CPB and simultaneous protamine administration. Delay of protamine administration revealed that protamine, and not the cessation of CPB is primarily responsible for the rapidly reduced HBP concentration. At the arrival to the ICU, the median HBP levels were 24.8 (15.6-38.1) ng/mL for CABG patients compared with 50.5 (36.5-104.6) ng/mL for complex surgery patients (p=0.004). One day after surgery, HBP levels in all three groups were below the proposed cutoff of 30 ng/mL, previously found to predict development of organ dysfunction during infection, while other biomarkers for infections remained elevated.ConclusionsHBP levels are elevated by administration of heparin and the use of CPB but reduced by protamine administration. At postoperative day one, HBP levels were below the threshold for infection with organ dysfunction, indicating that postoperative HBP measurement may be a better screening tool for postoperative infections than other biomarkers of infections that remain elevated after surgery.

Dynamics of heparin binding protein in cardiothoracic surgery using cardiopulmonary bypass – exploring its potential as a marker for postoperative infections.

2020 ◽  
Author(s):  
Niklas Sterner ◽  
Jane Fisher ◽  
Louise Thelaus ◽  
Carolin Ketteler ◽  
Spela Lemez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Organ Dysfunction ◽  
Binding Protein ◽  
Surgical Trauma ◽  
Heparin Binding ◽  
Postoperative Infections ◽  
Heparin Binding Protein ◽  
Heparin Administration ◽  
Protamine Administration

Abstract Background Surgical trauma and cardiopulmonary bypass (CPB) cause an inflammatory response, difficult to differentiate from postoperative infections. Heparin-binding protein (HBP) is released from neutrophils and has been shown to predict infection-related organ dysfunction and disease progression to severe sepsis. The aim of this study was to investigate the pre-, intra- and postoperative dynamics of HBP in cardiac surgery using CPB, in order to explore the usefulness of HBP as a biomarker for postoperative infections. Methods and Results Thirty patients undergoing cardiac surgery with CPB were included, of which 15 underwent coronary artery bypass grafting (CABG) surgery and 15 underwent complex procedures with longer CPB time. A reference group of ten patients undergoing lung surgery without CPB was also included. HBP was measured at nine different time points during surgery. Our results showed that HBP levels were not affected by surgical trauma itself. An increase in HBP levels was observed immediately following heparin administration and further increased during CPB. Prior to protaminization, we measured higher peak in HBP-levels in the complex group 345.7 (287.8-472.6) ng/mL compared with the CABG group 152.7 (85.3-204.0) ng/mL, p <0.001. HBP decreased rapidly following end of CPB and simultaneous protamine administration. Delay of protamine administration revealed that protamine, and not the cessation of CPB is primarily responsible for the rapidly reduced HBP concentration. At the arrival to the ICU, the median HBP levels were 24.8 (15.6-38.1) ng/mL for CABG patients compared with 50.5 (36.5-104.6) ng/mL for complex surgery patients ( p =0.004). One day after surgery HBP levels in all three groups were below the proposed cutoff of 30 ng/mL previously found to predict development organ dysfunction during infection. There was a statistically significant correlation between CPB duration and peak HBP concentration (r=0.598, p =0.002). Conclusions HBP levels are elevated by administration of heparin and the use of CPB. However, at postoperative day one, HBP levels normalized regardless of surgical complexity, indicating that postoperative HBP measurement may be used as a screening tool for postoperative infections in cardiac surgery.

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