Heparin-coated bypass circuits (Carmeda) suppress the release of tissue plasminogen activator during normothermic coronary artery bypass graft surgery

Objectives: To study fibrinolysis in a homogenous first-time coronary artery bypass surgery (CABG) population in whom heparin-coated circuits were used. Design: A prospective, blinded, randomized, placebo-controlled study. Setting: A university hospital, tertiary care, intraoperative and postoperative intensive care unit. Participants: Twenty-one adult elective primary CABG patients. Interventions: Randomized circuit-type centrifugal pump, membrane oxygenator, rigid cardiotomy reservoir, either placebo (n = 10) or heparin-coated (n = 11) (Carmeda; Medtronic Inc., Anaheim, CA). Measurement and Main Results: Blood samples were analyzed for tissue plasminogen activator (TPA) activity, TPA antigen, plasminogen activator inhibitor-1 (PAI-1) activity, prothrombin complex F1.2, and antithrombin III (AT-III) at the following times: before cardiopulmonary bypass (CPB), during CPB (30 and 60 minutes), post-CPB, and day 1 postsurgery. TPA activity and antigen increased fivefold in the placebo group during CPB, whereas it did not even double in the heparin-coated group. PAI-1, F1.2, and AT-III were not different between groups. Conclusions: Heparin-coated CPB circuits reduced TPA release in this homogenous CABG population with routine heparin/protamine management.