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Preoperative Fragmin® treatment according to the FRIC study increases postoperative bleeding in CABG patients with unstable angina

Gillquist, C. and Schott, U. LU (1996) In Scandinavian Journal of Thoracic and Cardiovascular Surgery 30(SUPPL. 44). p.64-64
Abstract

OBJECT: Subcutaneously intermittent administration of low molecular weight heparin (LMWH-Fragmin®) - (120IU/kgx2 BW) - in unstable angina was introduced clinically during the last year at our Hospital, after reports of the FRISC and FRIC studies as an alternative to continous infusion of standard heparin. In such patients with need for CABG, no data on haemostasis or anticoagulation during CBP had been presented at its introduction at our clinic. The aim of the present study was to evaluate postoperative bleeding and the frequency of heparin resistance in CABG patients with a preoperative FRIC-regime. METHODS: Forty consecutive unstable angina patients undergoing CABG were studied. Sonoclot coagulation analyses (Sienco, USA),... (More)

OBJECT: Subcutaneously intermittent administration of low molecular weight heparin (LMWH-Fragmin®) - (120IU/kgx2 BW) - in unstable angina was introduced clinically during the last year at our Hospital, after reports of the FRISC and FRIC studies as an alternative to continous infusion of standard heparin. In such patients with need for CABG, no data on haemostasis or anticoagulation during CBP had been presented at its introduction at our clinic. The aim of the present study was to evaluate postoperative bleeding and the frequency of heparin resistance in CABG patients with a preoperative FRIC-regime. METHODS: Forty consecutive unstable angina patients undergoing CABG were studied. Sonoclot coagulation analyses (Sienco, USA), thrombelastography (TEG)(Hemoscope, USA), Hemochrone®-ACT, routine coagulation, haematological analyses and anti-Xa analyses were performed pre- and post-operatively. In the control group 20 patients had recieved continous infusion with standard heparin preoperatively. In the study group, 20 patients had recieved subcutaneously low molecular weight heparin (LMWH-Fragmin®) (120IU/kgx2 BW) preoperatively. RESULTS: There were no significant differences (p>0,05) in demographic data between the non-randomized groups. Significantly higher (p<0,05) postoperative bleeding was seen in the Fragmin® treated patients. There were no difference in heparin resistence between the groups. A significantly higher anti-Xa plasma level was found both preoperatively and postoperatively in the Fragmin treated patients. Both TEG and Sonoclot detected unreversed anti-Xa better than ACT. CONCLUSION: Fragmin in high dose (120 mgx2), subcutaneously administered some days before CABG surgery, increased postoperative bleeding as compared to preoperative standard heparin infusion. A standard protamine titration, being guided by ACT did not fully reverse anti-Xa postoperatively.

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published
in
Scandinavian Journal of Thoracic and Cardiovascular Surgery
volume
30
issue
SUPPL. 44
pages
1 pages
publisher
Scandinavian University Press
external identifiers
  • scopus:33747693789
ISSN
0036-5580
language
English
LU publication?
no
id
295a0e4f-e300-4f26-b735-f37ed81b279d
date added to LUP
2017-07-27 10:43:00
date last changed
2017-07-27 10:43:00
@article{295a0e4f-e300-4f26-b735-f37ed81b279d,
  abstract     = {<p>OBJECT: Subcutaneously intermittent administration of low molecular weight heparin (LMWH-Fragmin®) - (120IU/kgx2 BW) - in unstable angina was introduced clinically during the last year at our Hospital, after reports of the FRISC and FRIC studies as an alternative to continous infusion of standard heparin. In such patients with need for CABG, no data on haemostasis or anticoagulation during CBP had been presented at its introduction at our clinic. The aim of the present study was to evaluate postoperative bleeding and the frequency of heparin resistance in CABG patients with a preoperative FRIC-regime. METHODS: Forty consecutive unstable angina patients undergoing CABG were studied. Sonoclot coagulation analyses (Sienco, USA), thrombelastography (TEG)(Hemoscope, USA), Hemochrone®-ACT, routine coagulation, haematological analyses and anti-Xa analyses were performed pre- and post-operatively. In the control group 20 patients had recieved continous infusion with standard heparin preoperatively. In the study group, 20 patients had recieved subcutaneously low molecular weight heparin (LMWH-Fragmin®) (120IU/kgx2 BW) preoperatively. RESULTS: There were no significant differences (p&gt;0,05) in demographic data between the non-randomized groups. Significantly higher (p&lt;0,05) postoperative bleeding was seen in the Fragmin® treated patients. There were no difference in heparin resistence between the groups. A significantly higher anti-Xa plasma level was found both preoperatively and postoperatively in the Fragmin treated patients. Both TEG and Sonoclot detected unreversed anti-Xa better than ACT. CONCLUSION: Fragmin in high dose (120 mgx2), subcutaneously administered some days before CABG surgery, increased postoperative bleeding as compared to preoperative standard heparin infusion. A standard protamine titration, being guided by ACT did not fully reverse anti-Xa postoperatively.</p>},
  author       = {Gillquist, C. and Schott, U.},
  issn         = {0036-5580},
  language     = {eng},
  number       = {SUPPL. 44},
  pages        = {64--64},
  publisher    = {Scandinavian University Press},
  series       = {Scandinavian Journal of Thoracic and Cardiovascular Surgery},
  title        = {Preoperative Fragmin® treatment according to the FRIC study increases postoperative bleeding in CABG patients with unstable angina},
  volume       = {30},
  year         = {1996},
}