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The Annals of Thoracic Surgery, Vol 58, 799-804, Copyright © 1994 by The Society of Thoracic Surgeons
K Hashimoto, M Yamagishi, T Sasaki, M Nakano and H Kurosawa
The anticoagulant effect of heparin in the milieu of altered antithrombin
III levels was investigated in adult (n = 7) and pediatric (n = 14)
patients undergoing open heart operations. The pediatric patients were
subdivided into a control group (n = 8) and an antithrombin III group (n =
6), which received 1,000 units of antithrombin III. The reduction in
antithrombin III levels during cardiopulmonary bypass was obvious in
patients of all ages, showing a greater reduction (although not
statistically significant) in the pediatric patients. However, the
antithrombin III group patients maintained their preoperative levels of
antithrombin III. The elevated fibrinopeptide A levels in pediatric and
adult control group patients suggested that considerable subclinical plasma
coagulation occurred during open heart operations, especially during the
normothermic period of cardiopulmonary bypass and after the administration
of protamine. Antithrombin III levels in the children were the most
predictive (r = - 0.58; p < 0.001) for production of fibrinopeptide A
during moderate hypothermic cardiopulmonary bypass, but the heparin levels
were most predictive (r = -0.57, p < 0.03) in the adults. This result
may be related to the different actions of heparin when antithrombin III
levels are reduced. Supplementation with antithrombin III succeeded in
suppressing the activation of the coagulation cascade and resulted in no
statistical change in fibrinopeptide A levels at any time. We conclude that
heparin and (in some patients) antithrombin III levels are important
variables for the inhibition of fibrin formation and the possible
preservation of coagulation proteins.
ARTICLES
Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
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