Heparin-coated circuits reduce activation of granulocytes during cardiopulmonary bypass. A clinical study

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 104; no. 3; pp. 642 - 647
• Main Authors: Borowiec, J, Thelin, S, Bagge, L, Nilsson, L, Venge, P, Hansson, HE
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA AATS/WTSA 01.09.1992; Elsevier
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biochemical Phenomena; Biochemistry; Biological and medical sciences; Cardiopulmonary Bypass; Coronary Artery Bypass; Free Radicals; Granulocytes - chemistry; Granulocytes - enzymology; Heparin - administration & dosage; Humans; Lactoferrin - blood; Leukocyte Count; Male; Medical sciences; Middle Aged; Peroxidase - blood; Time Factors; Cardiopulmonary bypass; Human; Prevention; Granulocyte; Anesthesia; Intraoperative; Activation; Anticoagulant; Heparin; Extracorporeal circuit; Coatings
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/s0022-5223(19)34730-0

Activated granulocytes release highly active enzymes such as myeloperoxidase and lactoferrin, which can be involved in tissue destruction mediated by oxygen free radicals. Cardiopulmonary bypass has been reported to activate granulocytes. Bypass circuits coated with heparin have been shown to reduce release of granulocyte factors in experimental studies. In the present study, heparin-coated circuits were compared with noncoated circuits. In seven patients undergoing coronary bypass, heparin-coated circuits were used (group HC), and seven served as control patients (group C). In group HC the heparin dose was reduced to 75% (225 IU/kg). Group C had the standard dose of 300 IU/kg. No preoperative differences in myeloperoxidase and lactoferrin were observed between the groups. At the end of bypass in both groups, there was a significant increase of these enzymes (p less than 0.001) followed by a later decrease. In group HC, however, the release of myeloperoxidase was significantly lower than in group C (215 +/- 24 versus 573 +/- 133 micrograms/L, mean +/- standard error of the mean). The release of lactoferrin was significantly lower in group HC than in group C both at the end of cardiopulmonary bypass (659 +/- 79 versus 1448 +/- 121 micrograms/L) and 3 hours after bypass (224 +/- 37 versus 536 +/- 82 micrograms/L). Granulocytes as well as total number of leukocytes continued to increase until 1 hour after bypass (p less than 0.001) and then manifested a slow decrease. It was concluded that the use of heparin-coated circuits reduced the release of granulocyte factors because of lower activation of leukocytes.