Original Article

Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications

Authors: Duk-hee Chun, Seong-wan Baik, So Yeon Kim, Jae Kwang Shim, Jong Chan Kim, Young Lan Kwak
DOI: 10.1038/aps.2010.180


Aim: To evaluate the clinical impact of reduced heparin responsiveness (HRreduced) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB), and to identify the predictors of HRreduced.
Methods: A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis, 150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥300 s, and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HRreduced). The relationships between the HSI and postoperative MI, cardiac enzyme levels and preoperative risk factors of HRreduced were investigated.
Results: There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HRreduced patients. HRreduced occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.
Conclusion: HRreduced was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients, which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HRreduced.

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