Is There any Effectiveness of Fresh Frozen Plasma on Safe Heparinization Given During Cardiopulmonary Bypass Operation?

OBJECTIVE: In this study we aimed to investigate in the light of the literature.the efficacy of the fresh frozen plasma (FFP) given before the initial heparinization on achievement of adequate heparinization against heparin resistance (HR) during cardiopulmonary bypass (CPB).
METHODS: After obtaining the consent of the patients and the consent the institutional ethics committee, total of 50 patients older than 18 years old who had undergone cardiopulmonary bypass were enrolled to this study. Patients were randomly divided into two groups of 25 patients. The patients with liver and kidney failure were excluded from the study. The body weights, ages and the ACT values of the patients before heparinization were recorded. The group of patients given 2 units “Fresh Frozen Plasma” 15-30 minutes before heparinization was called the ‘Group W’ (Study Group), a group of patients who hasn’t given FFP was called ‘Group C’ (Control Group). Four minutes after application of the first dose of heparin (Nevparin® 5000 Ý.Ü./ mL heparin sodium), the control ACTs were measured (Actalyke Mini II ACT Analyzer Helena Lab.). The ACTs were repeated every half an hour and recorded. The patients with the value of ACT under 420 seconds were given additional doses of heparin according to their “Heparin dose-response curve”.
RESULTS: The differences between the ages, body weights and the initial ACT values of the two groups were not statistically significant. The differences of the ACT values measured about 4 minutes after the first dose of heparinization between the two groups were statistically significant. This value was 650.74±244.81 seconds in the study group while in the control group it was found 505.92±159.78 seconds respectively (p = 0.018). The differences of the ACT values measured about 4 minutes after implementing the first dose of heparin were statistically significant between the two groups. Additional dose of heparin was required at about 4% of the patients in the study group and at about 24% of patients in the control group (p=0.042). Statistically no difference was observed between the two groups as for the additional need of heparin dose in the first half an hour.
CONCLUSION: Since the diagnosis and treatment process is time-consuming and has a higher risk of death, especially in cases those who had to enter pump urgently and, in cases where ACT can not be measured frequently or the calibration of the measuring device of ACT in terms of reliability is suspicious, it was concluded that it is appropriate to give 2 units of FFP before full dose of heparinization in order to prevent heparin resistance or to make it more easily controllable.

Kardiyopulmoner Baypas Ameliyatlarýnda Heparinizasyon Güvenliði Açýsýndan Taze Donmuþ Plazmanýn Etkinliði Var mýdýr?

AMAÇ: Çalýþmamýzda kardiyopulmoner baypas (KPB) sýrasýnda, ilk heparinizasyon dozu öncesi verilen taze donmuþ plazmanýn (TDP) olasý heparin direnci (HD)’ne karþý yeterli heparinizasyonun saðlanmasýndaki etkinliðini literatürler eþliðinde araþtýrmayý amaçladýk.
YÖNTEMLER: Enstitü Etik Kurulu’nun ve hastalarýn onayý alýndýktan sonra ameliyatlarýnda kardiyopulmoner baypas uygulanan, 18 yaþýndan büyük toplam 50 olgu çalýþmaya alýndý. Hastalar rastgele 25’er kiþilik iki gruba ayrýldý. Karaciðer ve böbrek yetersizliði olan hastalar çalýþmaya alýnmadý. Olgularýn vücut aðýrlýklarý, yaþlarý ve heparin öncesi ACT deðerleri kaydedildi. Heparinizasyondan 15-30 dk. önce; 2 ünite “Taze Donmuþ Plazma” (TDP) verilen olgular “Çalýþma grubu” (ÇG); TDP verilmeyen olgular “Kontol grubu” (KG) olarak adlandýrýldý. Heparinizasyon için Nevparin® (5000 Ý.Ü./ mL heparin sodyum) (300 Ü/Kg) ÝV veriliþinden 4-6 dk. sonra kontrol ACT’lerine bakýldý (Actalyke Mini II ACT Analyzer Helena Lab.) ve takiben her 30 dk.’da bir ACT’ler yinelendi ve kaydedildi. ACT 420 sn.’nin altýnda bulunan hastalara “Heparin Doz Cevap Eðrisi”ne göre ek doz heparin verildi.
BULGULAR: Her iki grup arasýndaki yaþ, vücut aðýrlýklarý, baþlangýç ACT’leri arasýndaki farklar istatistiksel olarak anlamlý deðildi. Ýki grup arasýnda ilk doz heparinizasyondan yaklaþýk 4 dk. geçtikten sonra ölçülen ACT’ler arasýnda istatistiksel olarak anlamlý bir fark saptandý. Çalýþma grubunda 650.74±244.81 sn. bulunurken KG’de 505.92±159.78 sn. bulundu (p = 0.018). Ýlk doz heparin uygulamasýndan yaklaþýk 4 dk. geçtikten sonra ölçülen ACT deðerlerine göre iki grup arasýndaki ek doz heparin gereksinimi farký istatistiksel olarak anlamlý bulundu. Çalýþma grubunda % 4, KG’de hastalarýn % 24’üne ek doz heparin uygulamasý gerekmiþtir (p = 0.042). Ýlk yarým saatte gereksinim duyulan ek doz heparin miktarlarý arasýnda istatistiksel olarak fark yoktu.
SONUÇ: Tanýsýnýn, tedavisinin zaman alýcý ve ölüm riskinin yüksek olmasý nedeniyle “HD”nin önlenebilmesi ya da daha kolay denetlenebilir duruma gelmesi için özellikle acilen pompaya girilmesi gereken durumlarda ve sýk ACT ölçülemediði ya da ACT ölçüm cihazýnýn kalibrasyonundan þüphe duyulan durumlarda heparinizasyon güvenirliði açýsýndan tam doz heparinizasyon öncesi yaklaþýk 2 ünite TDP verilmesinin uygun olduðu kanýsýna varýldý.