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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 816-822, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LC John, GM Rees and IB Kovacs
The effect of heparin (5 U/ml) on platelet function was examined by
hemostatometry in vitro. A wide individual variation of this effect was
found in 290 patients who underwent cardiac operations: 8.6% (25)
experienced a proaggregatory effect, 58.6% (170) experienced a mild to
moderate inhibition of platelet function, and 32.8% (95) experienced a
severe inhibition. No significant difference was found among patient
characteristics, including antiplatelet medication, in these three
subgroups. In vitro measurements correlated significantly with ex vivo
measurements, that is, from blood taken after heparinization (p <
0.0001; r = 0.97, n = 15). In 111 patients who underwent cardiac surgical
intervention, a significant correlation (p < 0.0001; 0.4 < r <
0.52) was found between preoperative measurements of the degree of
inhibition of platelet function by heparin and the total postoperative
blood loss after 4, 12, and 18 hours. Similarly, there was a significant
difference (p < 0.0001) in the total blood loss at 4, 12, and 18 hours
between the subgroups that showed, in vitro, a mild to moderate inhibition
of platelet function preoperatively compared with a severe inhibition (713
+/- 43 ml versus 1172 +/- 76 ml at 18 hours). It is concluded that platelet
inhibition as a result of heparin varies among patients and appears to be a
previously unrecognized etiologic factor in bleeding after cardiopulmonary
bypass.
ARTICLES
Inhibition of platelet function by heparin. An etiologic factor in postbypass hemorrhage
Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, West Smithfield, London, England.
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