The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1172-1176, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Heparin resistance after intraoperative platelet-rich plasma harvesting
GS Wickey, JC Keifer, DR Larach, MR Diaz and DR Williams
Department of Anesthesia, University Hospital, Pennsylvania State University College of Medicine, Hershey.
Records of anticoagulation for cardiopulmonary bypass from 58 patients who
underwent elective coronary artery revascularization were analyzed to
determine whether the harvesting of autologous platelet-rich plasma
produces heparin resistance. The effect of preoperative heparin therapy on
anticoagulation for cardiopulmonary bypass after harvesting of
platelet-rich plasma was also evaluated. Patients were grouped by presence
of preoperative heparin therapy and type of blood component harvested
before cardiopulmonary bypass, including platelet-rich plasma, autologous
whole blood, both, or neither. The dose of heparin required to initiate and
to maintain anticoagulation for cardiopulmonary bypass was determined for
each patient, and the groups were compared by two-way analysis of variance.
Significantly more heparin was required to maintain anticoagulation for
cardiopulmonary bypass in the platelet-rich plasma group than in the groups
receiving autologous whole blood or no blood products. More heparin was
also required to initiate and to maintain anticoagulation for
cardiopulmonary bypass after preoperative heparin therapy. These results
reinforce the concept that anticoagulation during cardiopulmonary bypass
must be carefully monitored, and increased vigilance may be warranted in
patients after harvesting of platelet- rich plasma.
