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Eur J Cardiothorac Surg 2004;26:947-950
© 2004 Elsevier Science NL

How much heparin do we really need to go on pump? A rethink of current practices

Cork University Hospital, Cork, Ireland

Received 26 August 2003; received in revised form 1 June 2004; accepted 1 July 2004.

^* Corresponding author. Address: 10 Orby Drive, The Gallops, Leopardstown, Dublin D18, Ireland. Tel.: +353-87-2244262; fax: +353-1-2130971. (E-mail: msampca{at}msn.com).

Objectives: Patients undergoing myocardial revascularisation using extracorporeal circulation require heparin anticoagulation. We aimed to evaluate the effect of reducing heparin dosage on target activated clotting time (ACT) and postoperative blood loss. Methods: In a prospective randomised trial, 195 patients undergoing isolated primary CABG were randomised into four groups A, B, C, and D receiving an initial heparin dosage of 100, 200, 250 and 300iu/kg, respectively. Extra incremental heparin (50iu/kg) was added if required to achieve a target ACT of 480s before initiating cardiopulmonary bypass. Postoperative blood loss was measured from the time of heparin reversal to drain removal 24h later. Results: Target ACT was achieved in 0, 63, 68.3 and 82.4% of patients in groups A, B, C and D, respectively, after the initial dose of heparin. In group B, of those not achieving target act a single increment of heparin was sufficient to achieve target ACT in further 18.6%. The mean ACT after the initial dose in groups B, C and D was 482.9, 519 and 588s, respectively (P<0.05). Postoperative blood loss in millilitre per kilogram was directly proportional to preoperative heparin dose. Conclusions: Patients receiving lower dose of heparin has lower postoperative blood loss. Of those achieving the target ACT, group B was significantly the closest to the target ACT. A starting dose of 200iu/kg of heparin and if necessary one 50iu/kg increment achieved target ACT in 81.5% of patients. The added benefit of significant drop in postoperative blood loss is evident.

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