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The use of minimized extracorporeal circulation system has a beneficial effect on hemostasis--a randomized clinical study.
Heart Surg Forum. 2006; 9(1):E543-8.HS

Abstract

BACKGROUND

Conventional cardiopulmonary bypass (CPB) is associated with increased coagulation and fibrinolytic activity. A closed miniaturized bypass circuit (CorX) features a significantly reduced tubing set, an integrated pump, and an air removal system without a cardiotomy reservoir. In a prospective randomized trial, the effects on hemostasis were investigated while comparing CorX with conventional CPB in patients undergoing coronary artery bypass grafting.

METHODS

Over a period of 1 year, 81 patients were randomly assigned either to the CorX system (n = 39, group A) or standard CPB system (n = 42, group B). Primary endpoints were platelet count, plasmin-antiplasmin complex (PAP), prothrombin fragments 1+2 (F1+F2), D-dimers, and fibrinogen. Secondary end-points were hematocrit, blood loss in the first 12 hours postoperatively, transfused packed red blood cells, and fresh frozen plasma in the first 24 hours postoperatively. In addition, we analyzed partial thromboplastin time, prothrombin time, and antithrombin III.

RESULTS

After aortic declamping, PAP complex and prothrombin F1+F2 were significantly lower in group A than in group B. The difference in D-dimers between groups reached significance at 1 hour post-CPB. Hematocrit values at the end of CPB measured 26 +/- 6% in group A versus 22 +/- 4% in group B (P = .01). The rest of the observed parameters did not significantly differ between groups.

CONCLUSION

Postoperative blood loss was not reduced in the present study. However, the use of the CorX system leads to a significant suppression of activation of coagulation and fibrinolytic cascades compared to conventional CPB, suggesting that miniaturized extracorporeal circuits are a step forward toward reduced imbalance of hemostasis in cardiac surgery.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. abdel-rahman@em.uni-frankfurt.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16403712

Citation

Abdel-Rahman, Ulf, et al. "The Use of Minimized Extracorporeal Circulation System Has a Beneficial Effect On Hemostasis--a Randomized Clinical Study." The Heart Surgery Forum, vol. 9, no. 1, 2006, pp. E543-8.
Abdel-Rahman U, Martens S, Risteski P, et al. The use of minimized extracorporeal circulation system has a beneficial effect on hemostasis--a randomized clinical study. Heart Surg Forum. 2006;9(1):E543-8.
Abdel-Rahman, U., Martens, S., Risteski, P., Ozaslan, F., Riaz, M., Moritz, A., & Wimmer-Greinecker, G. (2006). The use of minimized extracorporeal circulation system has a beneficial effect on hemostasis--a randomized clinical study. The Heart Surgery Forum, 9(1), E543-8.
Abdel-Rahman U, et al. The Use of Minimized Extracorporeal Circulation System Has a Beneficial Effect On Hemostasis--a Randomized Clinical Study. Heart Surg Forum. 2006;9(1):E543-8. PubMed PMID: 16403712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of minimized extracorporeal circulation system has a beneficial effect on hemostasis--a randomized clinical study. AU - Abdel-Rahman,Ulf, AU - Martens,Sven, AU - Risteski,Petar, AU - Ozaslan,Feyzan, AU - Riaz,Musawir, AU - Moritz,Anton, AU - Wimmer-Greinecker,Gerhard, PY - 2006/1/13/pubmed PY - 2006/12/9/medline PY - 2006/1/13/entrez SP - E543 EP - 8 JF - The heart surgery forum JO - Heart Surg Forum VL - 9 IS - 1 N2 - BACKGROUND: Conventional cardiopulmonary bypass (CPB) is associated with increased coagulation and fibrinolytic activity. A closed miniaturized bypass circuit (CorX) features a significantly reduced tubing set, an integrated pump, and an air removal system without a cardiotomy reservoir. In a prospective randomized trial, the effects on hemostasis were investigated while comparing CorX with conventional CPB in patients undergoing coronary artery bypass grafting. METHODS: Over a period of 1 year, 81 patients were randomly assigned either to the CorX system (n = 39, group A) or standard CPB system (n = 42, group B). Primary endpoints were platelet count, plasmin-antiplasmin complex (PAP), prothrombin fragments 1+2 (F1+F2), D-dimers, and fibrinogen. Secondary end-points were hematocrit, blood loss in the first 12 hours postoperatively, transfused packed red blood cells, and fresh frozen plasma in the first 24 hours postoperatively. In addition, we analyzed partial thromboplastin time, prothrombin time, and antithrombin III. RESULTS: After aortic declamping, PAP complex and prothrombin F1+F2 were significantly lower in group A than in group B. The difference in D-dimers between groups reached significance at 1 hour post-CPB. Hematocrit values at the end of CPB measured 26 +/- 6% in group A versus 22 +/- 4% in group B (P = .01). The rest of the observed parameters did not significantly differ between groups. CONCLUSION: Postoperative blood loss was not reduced in the present study. However, the use of the CorX system leads to a significant suppression of activation of coagulation and fibrinolytic cascades compared to conventional CPB, suggesting that miniaturized extracorporeal circuits are a step forward toward reduced imbalance of hemostasis in cardiac surgery. SN - 1522-6662 UR - https://www.unboundmedicine.com/medline/citation/16403712/The_use_of_minimized_extracorporeal_circulation_system_has_a_beneficial_effect_on_hemostasis__a_randomized_clinical_study_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -