Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study
Abstract Background Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass gra...
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BMC
2025-01-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-024-03267-9 |
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| author | Fei Jiang Yang Xu Shan-shan Hu Jin-quan Wang Yun-tai Yao the Evidence in Cardiovascular Anesthesia (EICA) Group |
| author_facet | Fei Jiang Yang Xu Shan-shan Hu Jin-quan Wang Yun-tai Yao the Evidence in Cardiovascular Anesthesia (EICA) Group |
| author_sort | Fei Jiang |
| collection | DOAJ |
| description | Abstract Background Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes. Methods HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results. We analyzed 503 OPCAB patients aged 31–80 years from September 2019 to June 2022, who were categorized into HR (n = 56) and Non-HR (n = 447) groups. The primary outcome was postoperative bleeding volume. Secondary outcomes included the incidence of postoperative reoperation for bleeding, allogenic blood transfusion incidences and volumes, and laboratory variables. Results Significant differences were observed in preoperative platelet counts (P < 0.001) and the ACT measured 2 h post-heparin neutralization (P = 0.012). The group HR exhibited higher 24-hour bleeding volumes, increased reoperation rates, and greater total bleeding volumes (all P < 0.001). Conclusions Postoperative HR was found to be prevalent in OPCAB patients and increased bleeding risks. These findings indicate the need for future randomized controlled trials to confirm the impact of HR and guide patient blood management. |
| format | Article |
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| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-7dd0b5f9f129463697c02a1f729b0a3e2025-01-05T12:45:45ZengBMCJournal of Cardiothoracic Surgery1749-80902025-01-012011610.1186/s13019-024-03267-9Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective studyFei Jiang0Yang Xu1Shan-shan Hu2Jin-quan Wang3Yun-tai Yao4the Evidence in Cardiovascular Anesthesia (EICA) Group5Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and ScienceDepartment of Pain, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and ScienceDepartment of Anesthesiology, Gansu Province Maternity and Child Health Care Hospital (Gansu Province Central Hospital)Department of Anesthesiology, Lu’an Affiliated Hospital of Anhui Medical UniversityDepartment of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical SciencesDepartment of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and ScienceAbstract Background Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes. Methods HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results. We analyzed 503 OPCAB patients aged 31–80 years from September 2019 to June 2022, who were categorized into HR (n = 56) and Non-HR (n = 447) groups. The primary outcome was postoperative bleeding volume. Secondary outcomes included the incidence of postoperative reoperation for bleeding, allogenic blood transfusion incidences and volumes, and laboratory variables. Results Significant differences were observed in preoperative platelet counts (P < 0.001) and the ACT measured 2 h post-heparin neutralization (P = 0.012). The group HR exhibited higher 24-hour bleeding volumes, increased reoperation rates, and greater total bleeding volumes (all P < 0.001). Conclusions Postoperative HR was found to be prevalent in OPCAB patients and increased bleeding risks. These findings indicate the need for future randomized controlled trials to confirm the impact of HR and guide patient blood management.https://doi.org/10.1186/s13019-024-03267-9Heparin reboundBleedingProtamineActivated coagulation timeOff-pump coronary artery bypass grafting |
| spellingShingle | Fei Jiang Yang Xu Shan-shan Hu Jin-quan Wang Yun-tai Yao the Evidence in Cardiovascular Anesthesia (EICA) Group Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study Journal of Cardiothoracic Surgery Heparin rebound Bleeding Protamine Activated coagulation time Off-pump coronary artery bypass grafting |
| title | Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study |
| title_full | Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study |
| title_fullStr | Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study |
| title_full_unstemmed | Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study |
| title_short | Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study |
| title_sort | heparin rebound in patients undergoing off pump coronary artery bypass grafting surgery a single center retrospective study |
| topic | Heparin rebound Bleeding Protamine Activated coagulation time Off-pump coronary artery bypass grafting |
| url | https://doi.org/10.1186/s13019-024-03267-9 |
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