A Prospective, Randomized Platelet-Function Study of Heparinized Oxygenators and Cardiotomy Suction

Objective: The purpose of this study was to determine if substitution of a heparin-coated oxygenator and salvaged autologous blood for cardiotomy suction would improve platelet function. Design: A prospective, randomized trial. Setting: A large academic medical center. Participants: Sixty adult patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB). Interventions: Patients were randomized into 1 of 4 groups in a 2 × 2 factorial design by oxygenator (heparinized v nonheparinized) and blood salvage during CPB (cardiotomy suction v salvaged autologous blood). Measurements and Main Results: Primary outcome measures were platelet function, glass-bead retention, platelet dense-body adenosine triphosphate secretion, platelet-rich plasma (PRP) aggregometry, Plateletworks platelet-function analyzer (Helena Laboratories Corp, Allen Park, MI), and platelet count. Secondary outcome measures were chest-tube drainage and allogeneic blood transfusion requirements. All platelet-function tests except thrombin-receptor activator peptide-induced PRP aggregometry showed a reduction in platelet function during and immediately after CPB (all p < 0.05). The only statistically significant difference in platelet-function tests between the groups was the glass-bead assay at 5 minutes before discontinuation of CPB (p < 0.05). This difference resolved 10 minutes after protamine administration. There were no differences between the groups in the amount of blood transfused, chest-tube drainage, and routine laboratory test results. Conclusions: The authors concluded that the effects of these changes to the CPB circuit were small and inconsequential in this cohort of patients.