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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 642-647, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Borowiec, S Thelin, L Bagge, L Nilsson, P Venge and HE Hansson
Activated granulocytes release highly active enzymes such as
myeloperoxidase and lactoferrin, which can be involved in tissue
destruction mediated by oxygen free radicals. Cardiopulmonary bypass has
been reported to activate granulocytes. Bypass circuits coated with heparin
have been shown to reduce release of granulocyte factors in experimental
studies. In the present study, heparin-coated circuits were compared with
noncoated circuits. In seven patients undergoing coronary bypass,
heparin-coated circuits were used (group HC), and seven served as control
patients (group C). In group HC the heparin dose was reduced to 75% (225
IU/kg). Group C had the standard dose of 300 IU/kg. No preoperative
differences in myeloperoxidase and lactoferrin were observed between the
groups. At the end of bypass in both groups, there was a significant
increase of these enzymes (p less than 0.001) followed by a later decrease.
In group HC, however, the release of myeloperoxidase was significantly
lower than in group C (215 +/- 24 versus 573 +/- 133 micrograms/L, mean +/-
standard error of the mean). The release of lactoferrin was significantly
lower in group HC than in group C both at the end of cardiopulmonary bypass
(659 +/- 79 versus 1448 +/- 121 micrograms/L) and 3 hours after bypass (224
+/- 37 versus 536 +/- 82 micrograms/L). Granulocytes as well as total
number of leukocytes continued to increase until 1 hour after bypass (p
less than 0.001) and then manifested a slow decrease. It was concluded that
the use of heparin-coated circuits reduced the release of granulocyte
factors because of lower activation of leukocytes.
ARTICLES
Heparin-coated circuits reduce activation of granulocytes during cardiopulmonary bypass. A clinical study
Department of Thoracic, University Hospital, Uppsala, Sweden.
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