Influence of different anticoagulation regimens on platelet function during cardiac surgery

Abstract

Qualitative platelet defects are of great importance as a cause of bleeding in cardiac surgery. We have studied the effects of different anticoagulation regimens on platelet function in 60 patients undergoing elective aorto-coronary bypass grafting with cardiopulmonary bypass (CPB). Patients were allocated randomly to four groups (each group n = 15) to receive either: bovine heparin 300 u. kg-1 (standard); heparin 300 u. kg-1 followed by a continuous infusion of 10,000 u. kg-1 until the end of CPB; heparin 600 u. kg-1; or heparin 600 u. kg-1 in addition to high-dose aprotinin 2 million iu before CPB, 500,000 iu h-1 until the end of operation and 2 million iu added to the prime. Platelet function was evaluated by aggregometry (turbidometric technique) using adenosine triphosphate (ADP) 2.0 mumol litre-1, collagen 4 microliters ml-1, adrenaline 25 mumol litre-1 and saline solution (control) as inducers. Both maximum aggregation and maximum gradient of aggregation were measured in arterial blood samples before, during and after CPB until the first day after operation. Mean total dose of heparin given in groups 2, 3 and 4 was more than 50,000 u. and differed significantly from that of group 1 (28,150 (SD 4700)u.). Platelet aggregation variables were most depressed during CPB and until the end of surgery in groups 2 and 3 (maximum aggregation - 54% to - 75% of baseline values). In the postoperative period, platelet function recovered but did not completely reach baseline values in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)