JAPANESE CIRCULATION JOURNAL
Online ISSN : 1347-4839
Print ISSN : 0047-1828
ISSN-L : 0047-1828
Clinical Study
Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery
Blood Conservation and Graft Patency
Kazuhiro HashimotoKatsuhisa OnoguchiTatsuumi SasakiTakashi HachiyaHiromitsu TakakuraRyuichi NagahoriSigeyuki Takeuchi
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JOURNAL FREE ACCESS

1999 Volume 63 Issue 3 Pages 165-169

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Abstract

The minimal effective dose of aprotinin on hemostasis under normothermic perfusion, the influence of anticoagulant therapy on graft patency, and the thromboembolic and hemorrhagic events were investigated after aortocoronary bypass graft operation (CABG). One hundred CABG patients under normothermic perfusion were randomly divided into the following groups: (1) coumadin plus acetylsalicylic acid (ASA) (n=32); no aprotinin used during cardiopulmonary bypass (CPB); (2) minimal-dose, 106 KIU during CPB, aprotinin used, followed by ASA and coumadin (n=36); and (3) very low-dose, total of 2×106 KIU before CPB and during CPB; aprotinin used; anticoagulation therapy with heparin early after surgery and followed by replacement with ASA and coumadin (n=32). The patency of arterial grafts was 100% in all groups. The patency of vein grafts was 95-98% and there was no difference among the groups. The blood loss was significantly reduced in both aprotinin groups (groups 2 and 3) compared to the coumadin plus ASA group, although no difference existed between the 2 aprotinin groups. Postoperative thrombotic and hemorrhagic events were not observed in any group. From this study, it was concluded that 106 KIU aprotinin in pump-prime-only followed by oral ASA and coumadin was the recommendation from the benefit/cost consideration. (Jpn Circ J 1999; 63: 165 - 169)

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© 1999 THE JAPANESE CIRCULATION SOCIETY
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