PMID- 17339186
OWN - NLM
STAT- MEDLINE
DCOM- 20070425
LR  - 20190608
IS  - 1592-8721 (Electronic)
IS  - 0390-6078 (Linking)
VI  - 92
IP  - 3
DP  - 2007 Mar
TI  - Surgical bleeding after pre-operative unfractionated heparin and low molecular 
      weight heparin for coronary bypass surgery.
PG  - 366-73
AB  - BACKGROUND AND OBJECTIVES: Since the impairment of platelet function may cause 
      excess peri-operative bleeding, pre-operative discontinuation of aspirin and 
      heparin bridging are common for cardiac surgery. We evaluated the impact of 
      pre-operative administration of enoxaparin and unfractionated heparin (UFH) on 
      coagulation parameters and peri-operative bleeding in patients undergoing 
      elective coronary artery bypass grafting (CABG) surgery after discontinuation of 
      aspirin. DESIGN AND METHODS: Forty-three patients with three-vessel coronary 
      artery disease undergoing elective CABG surgery discontinued aspirin and were 
      randomized to receive either UFH 180 UI/Kg x 2/day s.c. or enoxaparin 100 UI/Kg x 
      2/day s.c. until 12 h before surgery (median pre-operative treatment 8 days, 
      range 6-12 days). Surgery was performed as usual with UFH. Neither UFH nor any 
      low molecular weight heparin was given in the immediate post-operative period. 
      The effects of UFH and enoxaparin were monitored by the activated partial 
      thromboplastin time (aPTT) and the Enox-test (sensitive to factor Xa inhibition) 
      using a Rapidpoint Coagulation Analyzer. aPTT and factor Xa activity were also 
      measured by standard methods. Peri-operative bleeding and the nadirs of 
      hemoglobin concentration, hematocrit and platelet count were monitored 
      post-operatively. RESULTS: Patients in the two groups were similar for number of 
      bypasses, on-pump time, total surgery time, and time from the last heparin 
      administration. Coagulation parameters increased significantly and similarly at 
      30 min and 6 h with both treatments, but returned within the normal range at 12 
      h. Hemoglobin, hematocrit and platelet counts significantly decreased to the same 
      extent after CABG and re-normalized at the same time. Transfusional requirements 
      of blood and plasma units were similar in the two groups. INTERPRETATION AND 
      CONCLUSIONS: From the kinetics of coagulation parameters and the evaluation of 
      bleeding, enoxaparin is a safe alternative to UFH as a bridging therapy to CABG 
      after discontinuation of aspirin.
FAU - Renda, Giulia
AU  - Renda G
AD  - Institute of Cardiology, G. d'Annunzio University, Chieti, Italy.
FAU - Di Pillo, Raffaele
AU  - Di Pillo R
FAU - D'Alleva, Alberto
AU  - D'Alleva A
FAU - Sciartilli, Adolfo
AU  - Sciartilli A
FAU - Zimarino, Marco
AU  - Zimarino M
FAU - De Candia, Erica
AU  - De Candia E
FAU - Landolfi, Raffaele
AU  - Landolfi R
FAU - Di Giammarco, Gabriele
AU  - Di Giammarco G
FAU - Calafiore, Antonio
AU  - Calafiore A
FAU - De Caterina, Raffaele
AU  - De Caterina R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - Italy
TA  - Haematologica
JT  - Haematologica
JID - 0417435
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Hemoglobins)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/administration & dosage/*adverse effects/therapeutic use
MH  - Blood Coagulation Tests
MH  - Blood Loss, Surgical/prevention & control/*statistics & numerical data
MH  - *Coronary Artery Bypass
MH  - Coronary Disease/surgery
MH  - Elective Surgical Procedures
MH  - Enoxaparin/administration & dosage/*adverse effects/therapeutic use
MH  - Factor Xa/analysis
MH  - Female
MH  - Hemoglobins/analysis
MH  - Heparin/administration & dosage/*adverse effects/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Platelet Count
MH  - Postoperative Complications/prevention & control
MH  - Postoperative Hemorrhage/chemically induced
MH  - Preanesthetic Medication/*adverse effects
MH  - Preoperative Care/*adverse effects
MH  - Sample Size
MH  - Thrombosis/prevention & control
EDAT- 2007/03/07 09:00
MHDA- 2007/04/26 09:00
CRDT- 2007/03/07 09:00
PHST- 2007/03/07 09:00 [pubmed]
PHST- 2007/04/26 09:00 [medline]
PHST- 2007/03/07 09:00 [entrez]
AID - 10.3324/haematol.10913 [doi]
PST - ppublish
SO  - Haematologica. 2007 Mar;92(3):366-73. doi: 10.3324/haematol.10913.