Anticoagulation During Cardiopulmonary Bypass: First-Ever Guidelines Released
Recommendations focused on heparin dosing, contraindications and alternatives to heparin, and anticoagulation reversal.
HealthDay News — Clinical practice guidelines for anticoagulation therapy for cardiopulmonary bypass (CPB) have been developed and were published in the Annals of Thoracic Surgery.
Noting that the evidence base relating to anticoagulation therapy for CPB has not been organized into a succinct guideline and that considerable practice variability exists, Linda Shore-Lesserson, MD, from the Zucker School of Medicine at Hofstra Northwell in Hampstead, NY, and colleagues conducted a systematic literature review to establish best practices in anticoagulation therapy for CPB. Data from 96 manuscripts were reviewed, and 17 manuscripts, considered sentinel publications and published before 2000, were included to provide method, context, or additional supporting evidence.
The researchers developed recommendations based on review of the articles; for each recommendation they achieved more than two-thirds agreement. Recommendations were written in 3 areas: heparin dosing and monitoring for CPB initiation and maintenance; contraindications and alternatives to heparin; and anticoagulation reversal during cardiac procedures.
"It is hoped that this guideline will serve as a resource and will stimulate investigators to conduct more research and to expand on the evidence base on the topic of anticoagulation therapy for CPB," the authors wrote.
Shore-Lesserson L, Baker RA, Ferraris VA, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: clinical practice guidelines-anticoagulation during cardiopulmonary bypass. Ann Thorac Surg. 2018;105(2):650-662.