Heparin-coated extracorporeal bypass circuits: Fibrinolysis and coagulation activity in a clinical trial [Heparinbeschichtung des extrakorporalen kreislaufs: Gerinnungsaktivierung, verbrauch und fibrinolyse in einer randomisierten studie an koronarbypasspatienten]

Hemorrhage after cardiopulmonary bypass (CPB) is associated with increased fibrinolytic and clotting activity. As pathogenic factors artificial (nonbiologic) surface contact and damage of corpuscular blood components are discussed. The aim of this study was to evaluate the impact of heparin-coated circuits on coagulation and fibrinolytic parameters, platelet count and postoperative blood loss in low-risk cardiac patients. Fifty-two patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to totally heparin coated (Biolin(TM), Jostra, Hirrlingen, Germany) or identical uncoated extracorporeal circuits in a double blind protocol. Initial heparin dosage was equal for coated and uncoated circuits. Systemic anticoagulation was maintained with heparin in both groups. Coagulation and fibrinolytic parameters showed a parallel perioperative course. Postoperative platelet count was significantly higher with heparin coating (152 000/μl ± 46 000 vs. 125 000/μl ± 44 000, p = 0.029). Blood loss was lower with heparin coating but did not reach statistical significance. Heparin consumption was not reduced in heparin-coated circuits. Heparin coating of cardiopulmonary bypass circuits does not improve hemostatic disorders in low risk CABG patients. Higher postoperative platelet counts suggest clinical benefit for high-risk patients with extended duration of bypass. Our data do not support reducing systemic heparin doses with heparin-coated circuits.