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ABSTRACT
Background: Intravenous Panpharma heparin® was used in all on-pump cardiac surgery in our heart-surgery department for a short period. This brand of heparin replaced the previous Choay heparin® heparin supplied by the Sanofi-Aventis Laboratory. Unusual postoperative bleedings over this period prompted us to evaluate postoperative hemostasis by comparing these two heparins.
Methods: We compared data from patients who had undergone on-pump cardiac surgery during Panpharma heparin® period (group P, 257 patients) to those how received Choay heparin® (group C, 194 patients).
Results: Despite group P receiving a significantly lower dose of heparin (mean dose 21,000 IU/CEC) compared to group C (mean dose 22,000 IU/CEC) (p = 0.05), the number of surgical re-explorations needed to perfect postoperative hemostasis was significantly higher for group P (3.5% vs. 0) (p = 0.01). Heparin anti-Xa activity after surgery was higher in group P at postoperative h1 and h12 compared to group C, which explained reoperations for hemostasis.
Conclusion: Despite standardization, variations remain regarding anticoagulant activity between different manufacturing processes and heparin preparations. Surgical teams need to be aware that the biological effects of different brands of heparin may not be as expected and could endanger a usually safe procedure, such as cardiac surgery.
Article highlights
Heparin is a complex biological mixture of sulfated glycosaminoglycans, with a heterogeneous molecular weight and is produced using different methods and despite standardization, variations remain regarding anticoagulant activity between different manufacturing processes. In on-pump cardiac surgery minimal variations in heparin anticoagulant activity may cause serious side effects.
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Acknowledgments
We are greatly indebted to Ms. Dominique Faria, Ms. Martine Collomb and Mr. Didier Chassagnes for their precious help.
Declaration of interests
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Additional information
Notes on contributors
Kasra Azarnoush
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Bruno Pereira
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Aurelien Lebreton
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Marie-Christine Zenut
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Chouki Chenaf
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Damien Bouvier
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Nicolas d’Ostrevy
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.
Lionel Camilleri
KA: concept/design, data analysis/interpretation, drafting article, BP: statistical considerations, MCZ, CC: critical revision of the manuscript, AL, DB NdO: data collection, data analysis/interpretation, LC: final approval of the manuscript.