A STUDY OF HEPARIN RESISTANCE IN CORONARY ARTERY BYPASS GRAFT PATIENTS IN A TERTIARY CARE CENTRE
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Abstract
Background: This study was conducted to determine preoperative characteristics that may predict heparin resistance (HR) in patients scheduled for CABG (Coronary Artery Bypass Graft) surgery, as well as to estimate the percentage of patients who have heparin resistance among those undergoing CABG.
Methods: This study involved 120 patients who underwent CABG at the Department of Cardiothoracic and Vascular Surgery, Government Medical College Hospital, Thiruvananthapuram. This retrospective study was conducted over a six-month period, from January to December 2018, with written informed consent from the study participants and approval from the institutional ethics committee.
Results: The pre-operative features of the HR and NHR groups did not significantly differ from one another. The mean peri-operative heparin dose required for the HR group to attain the target ACT was 35588.37 +/- 4962.20, which was clearly greater, and the p value was 0.02, which was statistically significant. For the NHR group, the required dose was 32328.71 +/- 4714.89. We conducted a univariate analysis of patient characteristics for heparin resistance to determine which pre-operative features were predictive of post-operative heparin resistance. Of the variables evaluated, only heparin resistance showed a statistically significant correlation with the length of time the patient received pre-operative heparinization (p = 0.04). Additional patients were divided into two groups: pre-op antiplatelets and pre-op heparin. The purpose of this was to evaluate which group performed better in terms of post-operative hemodynamics and blood needs. A thorough examination of several post-operative factors in both groups showed that the pre-operative heparin group had a mean post-operative drain of 314.09 ± 95.83, while the pre-operative anti-platelet group had a mean post-operative drain of just 232.21 ± 88.80 (p = 0.009). The proportion of patients in both groups who needed post-operative transfusions also differed significantly. In the pre-operative heparin group, it was 23/47; in the pre-operative anti-platelet group, it was only 1/13, with a p-value of 0.009.
Conclusion: The only factor in our study that could predict heparin resistance was the length of pre-operative heparin use. Additionally, patients who got pre-operative heparin had a considerably higher blood loss and required more intraoperative blood transfusions than those who received pre-operative antiplatelet therapy.
Keywords: Heparin, Heparin Resistance, Non-Heparin Resistant, Antiplatelets, CABG (Coronary Artery Bypass Graft)
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Dr. Manoop B.
Assistant Professor, Department of General Surgery, Government Medical College Kottayam, Kerala, India.
Dr. Aravind Raman
Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Government Medical College Thiruvananthapuram, Kerala, India.
Dr. Akash
Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Government Medical College Thiruvananthapuram, Kerala India.
Dr. Krishna S.
Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Government Medical College Thiruvananthapuram, Kerala India.
Dr. T.D. Ravikumar
Professor and HOD, Department of Cardiothoracic and Vascular Surgery, Government Medical College Thiruvananthapuram, Kerala, India.