ArticleJournal of cardiothoracic surgery2025
Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study.
Article in Journal of cardiothoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHeparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes.
methodsHR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results. We analyzed 503 OPCAB patients aged 31-80 years from September 2019 to June 2022, who were categorized into HR (n = 56) and Non-HR (n = 447) groups. The primary outcome was postoperative bleeding volume. Secondary outcomes included the incidence of postoperative reoperation for bleeding, allogenic blood transfusion incidences and volumes, and laboratory variables.
resultsSignificant differences were observed in preoperative platelet counts (P < 0.001) and the ACT measured 2 h post-heparin neutralization (P = 0.012). The group HR exhibited higher 24-hour bleeding volumes, increased reoperation rates, and greater total bleeding volumes (all P < 0.001).
conclusionsPostoperative HR was found to be prevalent in OPCAB patients and increased bleeding risks. These findings indicate the need for future randomized controlled trials to confirm the impact of HR and guide patient blood management.
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