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Chapter 6 - Anticoagulation for Cardiopulmonary Bypass

Published online by Cambridge University Press:  24 October 2022

By
Martin Besser  and
Linda Shore-Lesserson
Edited by
Florian Falter ,
Albert C. Perrino, Jr  and
Robert A. Baker
Florian Falter
Affiliation:
Royal Papworth Hospital, Cambridge
Albert C. Perrino, Jr
Affiliation:
Yale University Medical Center, Connecticut
Robert A. Baker
Affiliation:
Flinders Medical Centre, Adelaide
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Summary

Anticoagulation is mandatory for any form of extra-corporeal circulation to prevent activation of the coagulation system through contact between blood and artificial surfaces and through blood stasis. The absence of sufficient anticoagulation is likely to result in clot formation within minutes of aortic cannulation and commencement of CPB, with detrimental consequences for the patient. This chapter briefly outlines the history of heparin before discussing its pharmacology, intraoperative hemostasis monitoring, the management of heparin resistance and Heparin Induced Thrombocytopenia (HIT) and the outlook for anticoagulation on CPB.

Keywords

Heparin PharmacologyHeparin MonitoringMaintenance of Heparin EffectHeparin ResistanceHeparin ReversalHeparin Induced Thrombocytopenia
Type
Chapter
Information
Cardiopulmonary Bypass , pp. 49 - 56
Publisher: Cambridge University Press
Print publication year: 2022

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References

Suggested Further Reading

Wardrop, D, Keeling, D. The story of the discovery of heparin and warfarin. Br J Haematol. 2008;141(6):757–763.CrossRefGoogle ScholarPubMed
Garcia, DA, Baglin, TP, Weitz, JI et al. Parenteral anticoagulants: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e24S–e43S.CrossRefGoogle ScholarPubMed
Bull, BS, Korpman, RA, Huse, WM et al. Heparin therapy during extracorporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg. 1975;69(5):674–684.CrossRefGoogle ScholarPubMed
Welsby, IJ, McDonnell, E, El-Moalem, H et al. Activated clotting time systems vary in precision and bias and are not interchangeable when following heparin management protocols during cardiopulmonary bypass. J Clin Monit Comput. 2002;17(5):287–292.Google Scholar
Pappalardo, F, Franco, A, Crescenzi, G et al. Anticoagulation management in patients undergoing open heart surgery by activated clotting time and whole blood heparin concentration. Perfusion. 2006;21(5):285–290.Google Scholar
Shore-Lesserson, L, Baker, RA, Ferraris, VA et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines – Anticoagulation during Cardiopulmonary Bypass. Anesth Analg. 2018.CrossRefGoogle Scholar
Miles, LF, Coulson, TG, Galhardo, C et al. Pump priming practices and anticoagulation in cardiac curgery: Results from the Global Cardiopulmonary Bypass Survey. Anesth Analg. December, 2017; 125(6):1871–1877.CrossRefGoogle Scholar
Lemmer, JH Jr., Despotis, GJ. Antithrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2002;123(2):213–217.Google Scholar
Chabata, CV, Frederiksen, JW, Sullenger, BA et al. Emerging applications of aptamers for anticoagulation and hemostasis. Curr Opin Hematol. 2018;25(5):382–388.Google Scholar

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