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OPCAB: which kind of anticoagulation?

Published online by Cambridge University Press:  01 June 2007

A. Koster
A. Koster*
Affiliation:
Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany
*
Correspondence to: Andreas Koster, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin. E-mail: Koster@dhzb.de; Tel: +49 30 4593 2600; Fax: +49 30 4593 2700
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Summary

Background and objectives

Despite the absence of cardiopulmonary bypass, systemic anticoagulation is needed for off-pump coronary artery bypass (OPCAB) surgery. The aim of the current review is to describe the influence of OPCAB surgery on hemostatic activation and to review the literature with regard to perioperative anticoagulation protocols in OPCAB surgery.

Methods

Research of the pertinent literature with appropriate terms for anticoagulation in OPCAB surgery.

Results

While during on-pump cardiac surgery a target activated clotting time (ACT) value of 400–480 is generally accepted, to date no standardized target ACT value for OPCAB surgery has been established. However, an ACT value of > 300 seconds is accepted by approximately 80% of US/Canadian surgeons and 60% of European surgeons. Even given the large variation commercially available heparins, the inter-individual variability of the effect of heparins on the ACT, and large differences in coagulation activation and ‘clot detection’ of currently used ACT systems, this target ACT corresponds to a heparin dose of approximately 150–300 IU/kg. New anticoagulant drugs have been proposed, acting through a selective anti-Xa activity (danaparoid) or directly inhibiting thrombin (bivalirudin).

Conclusions

Anticoagulation management is performed without any internationally accepted standard and, due to this and the lack of adequately powered studies, there is scarce information about the effects of OPCAB surgery on hemostatic activation in the immediate perioperative period. Although limited to two modest studies, bivalirudin appears to be an interesting option for the future.

Keywords

Graft potencyCoronary artery bypass graftingHemostatic activation
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 77 - 82
Copyright
Copyright © European Society of Anaesthesiology 2007

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