PMID- 26886138
OWN - NLM
STAT- MEDLINE
DCOM- 20180126
LR  - 20180126
IS  - 1365-2346 (Electronic)
IS  - 0265-0215 (Linking)
VI  - 33
IP  - 6
DP  - 2016 Jun
TI  - Identifying optimal heparin management during cardiopulmonary bypass in obese 
      patients: A prospective observational comparative study.
PG  - 408-16
LID - 10.1097/EJA.0000000000000431 [doi]
AB  - BACKGROUND: The heparin regimen providing anticoagulation during cardiopulmonary 
      bypass (CPB) is usually adapted to total body weight (TBW), but may be inaccurate 
      in obese patients in whom TBW exceeds their ideal body weight. OBJECTIVES: The 
      objective is to compare the effects of heparin injection based on TBW on 
      haemostatic parameters between obese and nonobese patients during cardiac surgery 
      and to calculate the optimal heparin regimen. DESIGN: Prospective comparative 
      study. SETTING: University hospital. PATIENTS: Two groups of 50 patients (BMI>/= or 
      <30 kg m) were included in the study over a 9-month period in 2013. The study 
      started on 27 February 2013. INTERVENTIONS: An unfractionated heparin (UFH) bolus 
      of 300 IU kg TBW was injected before initiation of CPB followed by additional 
      doses (50 to 100 IU kg) to maintain a target activated coagulation time (ACT) of 
      at least 400 s. MAIN OUTCOME MEASURES: ACT and plasma heparin concentration were 
      measured at different time points after initiation of, and weaning from CPB. 
      RESULTS: Obese patients received higher initial and total doses of heparin 
      (P < 0.0001). Plasma heparin concentrations were significantly higher in obese 
      patients at each time point (P < 0.001) and reached very high values after the 
      initial bolus (5.90 vs. 4.48 IU ml, P < 0.0001). The relationship between plasma 
      heparin concentration and ACT after the initial bolus was not linear and followed 
      an asymptotic regression curve. Haemoglobin concentration decreased 
      intraoperatively to a greater extent in the obese group (P < 0.001). No 
      significant differences in postoperative bleeding or global transfusion 
      requirements were observed. CONCLUSION: The standard heparin regimen based on TBW 
      in obese patients during CPB results in excessive plasma heparin concentrations 
      and a significant intraoperative decrease in haemoglobin concentration. ACT 
      monitoring was not accurate in identifying this excess dosage. An initial bolus 
      of 340 IU kg ideal body weight would achieve a heparin concentration of 
      4.5 IU ml, similar to that observed in nonobese patients. Further investigations 
      are warranted to confirm this heparin regimen.
FAU - Haas, Emmanuel
AU  - Haas E
AD  - From the Department of Anaesthesiology (EH, FF, FL, SD, OC, PMM, AS); Department 
      of Haematology (LG); and Department of Cardiovascular Surgery, Strasbourg 
      University Hospital, France (MK).
FAU - Fischer, Francois
AU  - Fischer F
FAU - Levy, Francois
AU  - Levy F
FAU - Degirmenci, Su-Emmanuelle
AU  - Degirmenci SE
FAU - Grunebaum, Lelia
AU  - Grunebaum L
FAU - Kindo, Michel
AU  - Kindo M
FAU - Collange, Olivier
AU  - Collange O
FAU - Mertes, Paul-Michel
AU  - Mertes PM
FAU - Steib, Annick
AU  - Steib A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - England
TA  - Eur J Anaesthesiol
JT  - European journal of anaesthesiology
JID - 8411711
RN  - 0 (Anticoagulants)
RN  - 0 (Hemoglobins)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage/blood/*therapeutic use
MH  - Blood Coagulation/drug effects
MH  - Body Weight
MH  - Cardiopulmonary Bypass/*methods
MH  - Female
MH  - Hemoglobins/analysis
MH  - Heparin/*administration & dosage/blood/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Obesity/*complications
MH  - Perioperative Care
MH  - Prospective Studies
MH  - Whole Blood Coagulation Time
EDAT- 2016/02/18 06:00
MHDA- 2018/01/27 06:00
CRDT- 2016/02/18 06:00
PHST- 2016/02/18 06:00 [entrez]
PHST- 2016/02/18 06:00 [pubmed]
PHST- 2018/01/27 06:00 [medline]
AID - 10.1097/EJA.0000000000000431 [doi]
PST - ppublish
SO  - Eur J Anaesthesiol. 2016 Jun;33(6):408-16. doi: 10.1097/EJA.0000000000000431.