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Stabilized infective endocarditis and altered heparin responsiveness during cardiopulmonary bypass

 Sungwon Na  ;  Jae Kwang Shim  ;  Duk-Hee Chun  ;  Dae Hee Kim  ;  Seong Wook Hong  ;  Young-Lan Kwak 
 WORLD JOURNAL OF SURGERY, Vol.33(9) : 1862-1867, 2009 
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Adult ; Anticoagulants/administration & dosage* ; Cardiopulmonary Bypass* ; Case-Control Studies ; Drug Monitoring ; Endocarditis/complications* ; Female ; Heparin/administration & dosage* ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications/etiology ; Prospective Studies ; Stroke/etiology
BACKGROUND: Although active infective endocarditis (IE) is known as a risk factor for decreased heparin responsiveness during cardiopulmonary bypass (CPB), evidence is lacking in patients with stabilized IE. We investigated whether heparin responsiveness was still altered in stabilized IE patients undergoing cardiac surgery in a prospective, controlled trial. METHODS: A total of 16 patients with stabilized IE without signs of active inflammation (IE group) and 48 patients without systemic infection (control group) undergoing valve surgery were included. Heparin responsiveness was assessed using the heparin sensitivity index (HSI), whereas heparin resistance was defined as an activated clotting time (ACT) occurring less than 400 s after the initial heparinization. RESULTS: Preoperative antithrombin III activity was lower and fibrinogen level was higher in the IE group. ACT after initial heparinization was shorter in the IE group. The HSI was lower and the number of patients with HSI <1.0 was greater in the IE group. Heparin resistance occurred more frequently in the IE group. CONCLUSIONS: Heparin responsiveness during CPB was significantly reduced in the IE group, and it seems to be associated with preoperative hypercoagulability and reduced antithrombin III activity. Therapeutic measures such as the administration of antithrombin III concentrate should be considered in these patients even when they are in a stabilized condition without active inflammation.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Dae Hee(김대희)
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Chun, Duk Hee(전덕희)
Hong, Seong Wook(홍성욱)
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