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Effect of low molecular weight heparin (Fragmin) on bleeding after cardiac surgery

Lookup NU author(s): S Clark

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Abstract

Background. Fragmin (Dalteparin, Pharmacia Ltd, Milton Keynes, UK) a low molecular weight heparin, is now recommended in the treatment of unstable angina. Due to the greater bioavailability and longer half-life of Fragmin compared with conventional heparin we postulated that this may influence postoperative bleeding after cardiac surgery for unstable angina. Methods. We investigated the influence of the agent on postoperative bleeding after cardiac surgery. Patients undergoing first-time coronary artery bypass grafting were prospectively studied in four groups: group A (n = 100) were elective patients; group B (n = 60) had unstable angina and received conventional heparin intravenously until operation group C (n = 115) received Fragmin with the last dose administered more than 12 hours before surgery; and group D (n = 115) received Fragmin within 12 hours of operation. Results. Patients in group D had significantly greater blood loss (p < 0.001) and increased blood transfusion than groups A, B, and C (p = 0.047), Patients receiving Fragmin more than 12 hours before surgery (group C) had similar rates of blood loss and transfusion to group B (p > 0.05) but greater than in group A (p = 0.021). There were no differences in reopening rate. Conclusions, The risks of bleeding and transfusion must be weighed against the risks of acute ischemic events if Fragmin is stopped more than 12 hours before operation. (C) 2000 by The Society of Thoracic Surgeons.


Publication metadata

Author(s): Clark SC, Vitale N, Zacharias J, Forty J

Publication type: Article

Publication status: Published

Journal: Annals of Thoracic Surgery

Year: 2000

Volume: 69

Issue: 3

Pages: 762-764

ISSN (print): 0003-4975

ISSN (electronic): 1552-6259

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/S0003-4975(99)01366-1

DOI: 10.1016/S0003-4975(99)01366-1


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