Abstract

LOBO FILHO, José Glauco et al. Standardization of the sodium heparin dose used in off-pump myocardial revascularization surgery. Rev Bras Cir Cardiovasc [online]. 2005, vol.20, n.3, pp. 279-285. ISSN 0102-7638.  http://dx.doi.org/10.1590/S0102-76382005000300008.

OBJECTIVE: To evaluate a methodology of anticoagulation during off pump coronary artery bypass surgery (CABS) that promotes safe anticoagulation during the procedure (Activated Coagulation Time >200 seconds), using an initial dose of 1 mg of sodium heparin/kg weight. METHOD: 40 patients (30 men and 10 women), ages ranging from 41 to 85 years, were submitted to off pump CABS, using an initial sodium heparin dose of 1mg/kg of weight. Ten minutes after that drug was administered, if the ACT was > 200 seconds, we initiated the revascularization procedure. If not, we administered an additional of 0.5mg/kg heparin. During the surgery, the ACT was measured at 30 intervals. After revascularization, heparin reversal was achieved with a dose of protamine chloride equal do the total heparin dose infused during the procedure (1:1). RESULTS: The mean ACT at 10 minutes after heparinization was 372.2 (+/-104.31) seconds, without significant statistical difference between gender and age groups (p>0.05). The ACT values at 30 and 60 minutes remained greater than 200 seconds in all patients. The ACT at 30 minutes showed a significant statistical difference between age groups and gender (p<0.05). After heparin reversal using protamine, all patients returned to their initial hemostasis level (ACT < 200s). CONCLUSION: The results show the safety and effectiveness of an initial sodium heparin dose of 1mg/kg of weight during off-pump CABS maintaining safe ACT (> 200s) even after 60 minutes of heparinization, independently of age and gender.

Keywords : Myocardial revascularization; Heparin; Whole blood coagulation time.