Does heparin rebound lead to postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass?

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Perfusion-Uk Pub Date : 2024-11-01 Epub Date: 2023-09-21 DOI:10.1177/02676591231199218
Marije Rijpkema, Eline A Vlot, Marco C Stehouwer, Peter Bruins
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Abstract

Background: Heparin rebound is a common observed phenomenon after cardiac surgery with CPB and is associated with increased postoperative blood loss. However, the administration of extra protamine may lead to increased blood loss as well. Therefore, we want to investigate the relation between heparin rebound and postoperative blood loss and the necessity to provide extra protamine to reverse heparin rebound.

Methods: We searched PubMed, Cochrane, EMBASE, Google Scholar and Web of Science to review the question: "Does heparin rebound lead to postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass." Combination of search words were framed within four major categories: heparin rebound, blood loss, cardiac surgery and cardiopulmonary bypass. All studies that met our question were included. Quality assessment was performed using the Cochrane risk of bias (RoB2) tool for randomized controlled trials and the risk of bias in non-randomized studies of intervention (ROBINS-I) for non-randomised trials.

Results: 4 randomized and 17 non-randomized studies were included. The mean incidence of heparin rebound was 40%. The postoperative heparin levels, due to heparin rebound, were often below or equal to 0.2 IU/mL. We could not demonstrate an association between heparin rebound and postoperative blood loss or transfusion requirements. However the quality of evidence was poor due to a broad variety of definitions of heparin rebound, measured by various coagulation tests and studies with small sample sizes.

Conclusion: The influence of heparin rebound on postoperative bleeding seems to be negligible, but might get significant in conjunction with incomplete heparin reversal or other coagulopathies. For that reason, it might be useful to get a picture of the entire coagulation spectrum after cardiac surgery, as can be done by the use of a viscoelastic test in conjunction with an aggregometry test.

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肝素反弹会导致体外循环心脏手术患者术后失血吗?
背景:肝素反弹是CPB心脏手术后常见的现象,与术后失血增加有关。然而,服用额外的鱼精蛋白也可能导致失血增加。因此,我们想研究肝素反弹与术后失血的关系,以及提供额外的鱼精蛋白来逆转肝素反弹的必要性。方法:我们搜索PubMed、Cochrane、EMBASE、Google Scholar和Web of Science,回顾“肝素反弹会导致体外循环心脏手术患者术后失血吗?”搜索词组合分为四大类:肝素反弹、失血、心脏手术和体外循环。所有符合我们问题的研究都包括在内。随机对照试验使用Cochrane偏倚风险(RoB2)工具进行质量评估,非随机试验使用非随机干预研究中的偏倚风险进行质量评估。结果:纳入4项随机和17项非随机研究。肝素反弹的平均发生率为40%。由于肝素反弹,术后肝素水平通常低于或等于0.2 IU/mL。我们无法证明肝素反弹与术后失血或输血需求之间的相关性。然而,由于肝素反弹的定义多种多样,通过各种凝血测试和小样本量研究测量,证据质量较差。结论:肝素反弹对术后出血的影响似乎可以忽略不计,但可能与肝素不完全逆转或其他凝血疾病有关。因此,了解心脏手术后的整个凝血谱可能是有用的,这可以通过使用粘弹性测试和聚集度测试来完成。
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来源期刊
Perfusion-Uk
Perfusion-Uk 医学-外周血管病
CiteScore
3.00
自引率
8.30%
发文量
203
审稿时长
6-12 weeks
期刊介绍: Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
期刊最新文献
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