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Gabexate mesilate and antithrombin III for intraoperative anticoagulation in heparin pretreated patients

M Ranucci

Department of Cardiac Anaesthesia, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, m.ranucci{at}galactica.it

A Cazzaniga

Department of Cardiac Anaesthesia, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan

G Isgrò

Department of Cardiac Anaesthesia, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan

A Ditta

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

A Boncilli

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

M Cotza

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

S Brozzi

Department of Cardiovascular Perfusion, Cardiovascular Centre ‘E. Malan’, S. Donato Hospital, University of Milan, Milan

Thirty patients scheduled for elective myocardial revascularization and having undergone preoperative heparin treatment have been admitted to this prospective, randomized study. The aim of the study was to test two different strategies for preserving circulating antithrombin III (AT-III) during cardiopulmonary bypass. Patients in the control group (group C, n = 10) were treated with a standard heparinization (300 IU/kg). Patients in group A (n = 10) received the same management plus two doses of purified antithrombin III (1000 IU each). Patients in group GA received 200 IU/kg heparin and a continuous infusion of heparin (100 IU/kg/h) and gabexate mesilate (2 mg/kg/h) plus the same dose of antithrombin III as group A. Both group A and group GA demonstrated a preservation of circulating AT-III when compared to group C; this effect was more pronounced in group GA. The total heparin dosage was less in group GA than in groups A and C. Purified AT-III administration is recommended in heparin pretreated patients; the addition of gabexate mesilate to this protocol decreases the heparin requirement and increases the AT-III preservation.

Perfusion, Vol. 14, No. 5, 357-362 (1999)
DOI: 10.1177/026765919901400507
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M. Ranucci, G. Isgro, A. Cazzaniga, A. Ditta, A. Boncilli, M. Cotza, G. Carboni, and S. Brozzi
Different patterns of heparin resistance: therapeutic implications
Perfusion, May 1, 2002; 17(3): 199 - 204.
[Abstract] [PDF]