Heparin-coating of extracorporea circuits reduces thrombin formation in patients undergoing cardiopulmonary bypass

This clinical study was performed to evaluate the inhibiting effects of heparin- coated extracorporeal circuits on thrombin formation during cardiopulmonary bypass (CPB). Thirty patients undergoing coronary artery bypass grafting were randomly divided into two groups with (Duraflo II, n=15) orwithout (control, n=15) the use of heparin-coated circuits. Standard systemic heparinization was performed in all the patients before CPB. The results showed that thrombin formation during the first phase of CPB was inhibited by heparin-coating identified by the significantly lower concentrations of thrombin-antithrombin III (TAT) complex formed in plasma in the Duraflo II group than in the control group (p <0.05). Heparin concentrations were higher in the Duraflo II group than in the control group at the end of CPB (p <0.05). However, after release of the aortic crossclamp in the second phase of CPB, thrombin became strongly activated in both the Duraflo II and the control groups indicated by a sharp increase of TAT complex as well as fibrinopeptide A. Thus, Duraflo II heparin-coating reduces thrombin formation in the early phase of CPB, however, this beneficial effect was counteracted after aortic crossclamp release by material-independent stimuli. Therefore, adequate systemic heparinization is still required despite improved haemocompatibility of the circuits offered by heparin-coating.

[1]  C. Wildevuur,et al.  Membrane oxygenator prevents lung reperfusion injury in canine cardiopulmonary bypass. , 1991, The Annals of thoracic surgery.

[2]  G. Sfakianakis,et al.  Cardiopulmonary bypass with a surface-heparinized extracorporeal perfusion system. , 1990, ASAIO transactions.

[3]  M. R. Rolfs,et al.  Evaluation of Duraflo II heparin immobilized cardiopulmonary bypass circuits. , 1990, ASAIO transactions.

[4]  M. Turina,et al.  Cardiopulmonary bypass without systemic heparinization. Performance of heparin-coated oxygenators in comparison with classic membrane and bubble oxygenators. , 1989, The Journal of thoracic and cardiovascular surgery.

[5]  R. Bartlett,et al.  Evaluation of Duraflo II heparin coating in prolonged extracorporeal membrane oxygenation. , 1988, ASAIO transactions.

[6]  R. G. Cornell,et al.  National experience with extracorporeal membrane oxygenation for newborn respiratory failure. Data from 715 cases. , 1988, ASAIO transactions.

[7]  W. van Oeveren,et al.  Review article : Blood compatibility of cardiopulmonary bypass circuits , 1987 .

[8]  O. Larm,et al.  Thrombin inactivation on surfaces with covalently bonded heparin. , 1986, Thrombosis research.

[9]  R. Bick.  Hemostasis Defects Associated with Cardiac Surgery, Prosthetic Devices, and Other Extracorporeal Circuits , 1985, Seminars in thrombosis and hemostasis.

[10]  S. W. Kim,et al.  Heparinized polyurethanes: in vitro and in vivo studies. , 1985, Journal of biomedical materials research.

[11]  R. Colman,et al.  Effect of heparin on the inactivation rate of human activated factor XII by antithrombin III. , 1985, Blood.

[12]  E. Salzman,et al.  Elevated Plasma Fibrinopeptide A ana Thromboxane B2 Levels During Cardiopulmonary Bypass , 1980, Circulation.

[13]  A. McKee,et al.  Twenty-four hour membrane oxygenation in dogs without anticoagulation. , 1976, Surgery.

[14]  W. Rea,et al.  LONG‐TERM MEMBRANE OXYGENATION WITHOUT SYSTEMIC HEPARINIZATION , 1972, Transactions - American Society for Artificial Internal Organs.

[15]  Rea Wj,et al.  Long-term membrane oxygenation without systemic heparinization. , 1972 .

[16]  R. Dutton,et al.  Heparin Bonding on Colloidal Graphite Surfaces , 1963, Science.