Effect of Heparin Loading During Congenital Heart Operation on Thrombin Generation and Blood Loss Sophronia O Turner-Gomes, MB, ChB, Evan P Nitschmann,

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Effect of Heparin Loading During Congenital Heart Operation on Thrombin Generation and Blood Loss Sophronia O Turner-Gomes, MB, ChB, Evan P Nitschmann, BSc, Geoffrey R Norman, PhD, Maureen E Andrew, MD, William G Williams, MD The Annals of Thoracic Surgery Volume 63, Issue 2, Pages 482-488 (February 1997) DOI: 10.1016/S0003-4975(96)01215-5

Fig. 1 Mediastinal blood loss up to 24 hours after operation was significantly less in the acyanotic than in the cyanotic children with congenital heart disease (p < 0.05) but was not significantly different between the high-dose and low-dose groups. Cardiopulmonary bypass (CPB) duration was a significant covariate factor for blood loss up to 24 hours after operation (p < 0.001). The Annals of Thoracic Surgery 1997 63, 482-488DOI: (10.1016/S0003-4975(96)01215-5)

Fig. 2 Plasma immunoglobulin G (IgG) values over time. Cardiopulmonary bypass resulted in hemodilution of 41% to 51% in all groups. There was no significant difference in the degree of hemodilution in the groups. (CPB = cardiopulmonary bypass; hypoth = at end of hypothermia; NS = not significant; post CPB = after start of CPB; post-hep = after heparin loading; post-op = 2 hours after operation; post-prot = after protamine administration; Pre-op = post anesthesia.) The Annals of Thoracic Surgery 1997 63, 482-488DOI: (10.1016/S0003-4975(96)01215-5)

Fig. 3 Heparin levels over time at the same time points as those in Fig. 1. Increased heparin in the prime solution raised plasma heparin levels above 3 U/mL after the start of cardiopulmonary bypass (p = 0.005). This concentration was better maintained throughout operation in the acyanotic groups than in the cyanotic groups (p < 0.001). (See Fig. 2 for key to abbreviations.) The Annals of Thoracic Surgery 1997 63, 482-488DOI: (10.1016/S0003-4975(96)01215-5)

Fig. 4 Thrombin–antithrombin III (TAT) values are plotted logarithmically. Time points are the same as those in Fig. 1. Levels were lower in acyanotic than in cyanotic patients with congenital heart disease (p < 0.01), but this difference could be accounted for by the difference in duration of cardiopulmonary bypass between the two groups. Increased heparin in the prime solution did not result in statistically significant differences in the thrombin–antithrombin III levels (p = 0.2). (See Fig. 2 for key to abbreviations.) The Annals of Thoracic Surgery 1997 63, 482-488DOI: (10.1016/S0003-4975(96)01215-5)

Fig. 5 D-dimer values are plotted logarithmically. Time points are the same as those in Fig. 1. D-dimer levels increased to a lesser degree in acyanotic than in the cyanotic patients with congenital heart disease (p < 0.01), but the difference could not be accounted for by the difference in duration of cardiopulmonary bypass between the two groups. There was a trend toward lower D-dimer values in the high-dose heparin than in the low-dose heparin group (p = 0.06). (See Fig. 2 for key to abbreviations.) The Annals of Thoracic Surgery 1997 63, 482-488DOI: (10.1016/S0003-4975(96)01215-5)