• Eur J Anaesthesiol · Mar 2020

    Heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass.

    • Hai-Ping Ma, Wei-Fang Xu, Jin Yu, Jiang Wang, and Hong Zheng.
    • From the Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China (H-PM, W-FX, JY, JW, HZ).
    • Eur J Anaesthesiol. 2020 Mar 1; 37 (3): 162-169.

    BackgroundHeparin-associated coagulation disorder is an important factor related to postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Currently, the relationship between heparin sensitivity and postoperative bleeding is unknown.ObjectiveTo investigate the relationship between individual heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery.DesignProspective controlled study.SettingTertiary teaching hospital, Urumqi, Xinjiang, PR China. The study was conducted from January 2016 to August 2018.PatientsA total of 195 adult patients undergoing cardiac valve replacement surgery were included.InterventionAfter initial heparin dosing (2.5 mg kg), patients were divided into three groups according to the whole blood activated clotting time (ACT): group A, insensitive group (ACT < 480 s); group B, sensitive group (480 s < ACT < 750 s); group C, hypersensitive group (ACT > 750 s).Main Outcome MeasuresFirst, intra-operative and 24-h postoperative blood loss. Second, antithrombin (AT) and factor X mRNA levels. Third, the plasma levels of AT-III and factor X. Fourth, heparin sensitivity index.ResultsBlood loss was approximately 20 to 25% lower in group B than in groups A and C, which was statistically significant (P < 0.01). The AT-III mRNA levels increased from groups A to C and was positively associated with heparin sensitivity; the factor X mRNA levels changed in the opposite direction; a significant difference was observed between groups A and C (P < 0.05). The factor X plasma level showed the same trend as its mRNA. The AT-III plasma level was significantly lower in group B than in groups A and C (P < 0.05).ConclusionPostoperative blood loss is related to heparin sensitivity in patients undergoing cardiac surgery, and the moderately sensitive patients have the least postoperative bleeding. Individual variation in heparin sensitivity is related to the mRNA and plasma levels of AT-III and factor X.Trial RegistrationRegistration number ChiCTR-RPC-17012259.

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