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Low-molecular-weight heparin (Fragmin) versus heparin for anticoagulation during cardiopulmonary bypass in open heart surgery, using a pig model

Bagge, L; Wahlberg, T; Holmer, E; Tydén, H; Nyström, S O and Malm, T LU (1994) In Blood Coagulation and Fibrinolysis 5(2). p.72-265
Abstract

Fragmin and heparin were studied in pigs during 120 min of cardiopulmonary bypass (CPB) and up to 240 min postoperatively, with respect to clotting, bleeding and the effects of protamine. Thirty-three pigs received bolus injections of 300 IU/kg with or without additional dosage during CPB and with or without subsequent protamine sulphate. Doses of Fragmin 60% higher were necessary to prevent clotting. These had 100% higher anti-FXa levels but about 50% shorter activated coagulation time (ACT) compared with heparin. Anti-FXa increased with cumulative doses of heparin and Fragmin but ACT and activated partial thromboplastin time (aPTT) did not, indicating a larger loss of thrombin inhibition compared with anti-FXa in both drugs during... (More)

Fragmin and heparin were studied in pigs during 120 min of cardiopulmonary bypass (CPB) and up to 240 min postoperatively, with respect to clotting, bleeding and the effects of protamine. Thirty-three pigs received bolus injections of 300 IU/kg with or without additional dosage during CPB and with or without subsequent protamine sulphate. Doses of Fragmin 60% higher were necessary to prevent clotting. These had 100% higher anti-FXa levels but about 50% shorter activated coagulation time (ACT) compared with heparin. Anti-FXa increased with cumulative doses of heparin and Fragmin but ACT and activated partial thromboplastin time (aPTT) did not, indicating a larger loss of thrombin inhibition compared with anti-FXa in both drugs during CPB. Thrombin inhibition was crucial for prevention of clotting. Protamine efficiently normalized ACT in the Fragmin group but left a residual 20% anti-FXa, which did not increase the bleeding tendency. Fragmin could adequately be monitored with ACT and would be a safe alternative to heparin in CPB.

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Please use this url to cite or link to this publication:
author
publishing date
type
Contribution to journal
publication status
published
keywords
Animals, Blood Loss, Surgical/prevention & control, Cardiac Surgical Procedures, Cardiopulmonary Bypass, Dalteparin/antagonists & inhibitors, Disease Models, Animal, Dose-Response Relationship, Drug, Female, Heparin/therapeutic use, Intraoperative Care, Male, Monitoring, Physiologic/methods, Postoperative Care, Protamines/therapeutic use, Random Allocation, Swine, Thrombosis/prevention & control
in
Blood Coagulation and Fibrinolysis
volume
5
issue
2
pages
8 pages
publisher
Lippincott Williams and Wilkins
external identifiers
  • scopus:0028278746
ISSN
0957-5235
language
English
LU publication?
no
id
9d6ffc6b-2643-449b-8ba0-5260f5af75a1
alternative location
https://journals.lww.com/bloodcoagulation/Abstract/1994/04000/Low_molecular_weight_heparin__FragminTM__versus.17.aspx
date added to LUP
2018-12-05 15:27:53
date last changed
2019-01-06 14:18:48
@article{9d6ffc6b-2643-449b-8ba0-5260f5af75a1,
  abstract     = {<p>Fragmin and heparin were studied in pigs during 120 min of cardiopulmonary bypass (CPB) and up to 240 min postoperatively, with respect to clotting, bleeding and the effects of protamine. Thirty-three pigs received bolus injections of 300 IU/kg with or without additional dosage during CPB and with or without subsequent protamine sulphate. Doses of Fragmin 60% higher were necessary to prevent clotting. These had 100% higher anti-FXa levels but about 50% shorter activated coagulation time (ACT) compared with heparin. Anti-FXa increased with cumulative doses of heparin and Fragmin but ACT and activated partial thromboplastin time (aPTT) did not, indicating a larger loss of thrombin inhibition compared with anti-FXa in both drugs during CPB. Thrombin inhibition was crucial for prevention of clotting. Protamine efficiently normalized ACT in the Fragmin group but left a residual 20% anti-FXa, which did not increase the bleeding tendency. Fragmin could adequately be monitored with ACT and would be a safe alternative to heparin in CPB.</p>},
  author       = {Bagge, L and Wahlberg, T and Holmer, E and Tydén, H and Nyström, S O and Malm, T},
  issn         = {0957-5235},
  keyword      = {Animals,Blood Loss, Surgical/prevention & control,Cardiac Surgical Procedures,Cardiopulmonary Bypass,Dalteparin/antagonists & inhibitors,Disease Models, Animal,Dose-Response Relationship, Drug,Female,Heparin/therapeutic use,Intraoperative Care,Male,Monitoring, Physiologic/methods,Postoperative Care,Protamines/therapeutic use,Random Allocation,Swine,Thrombosis/prevention & control},
  language     = {eng},
  number       = {2},
  pages        = {72--265},
  publisher    = {Lippincott Williams and Wilkins},
  series       = {Blood Coagulation and Fibrinolysis},
  title        = {Low-molecular-weight heparin (Fragmin) versus heparin for anticoagulation during cardiopulmonary bypass in open heart surgery, using a pig model},
  volume       = {5},
  year         = {1994},
}